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MEDITATIONS ON GOUT 



Like as a wily Foxe, that having spide, 
Where on a sunnie banke the Lambes doo play. 
Full closely creeping by the hinder side, 
Lyes in ambushment of his hoped pray. 

SPENSER : The Fate of the Butterfly. 



TO 

DAVID LITTLE, M.D., 

THE EXCITING CAUSE, 

AND 

ENOCH V. STODDARD, M.D. 

A STRONGLY PREDISPOSING CAUSE 
OF THIS MONOGRAPH — 

STfjest: lEcBttattons 

ARE RESPECTFULLY INSCRIBED, 



PREMONS7R/17ION 




Read many such, and then ask what is to be done. 
ROBERT BURTON, The Anatomy of Melancholy. 

T already enter eth into the 
hen of the Physician, and the 
General Reader may he made 
to perceive in like degree that 
all formulae how subtile so- 
ever for the assuagement and 
ordering of Gout are Not Absolute. It is not 
within the power of The Author, therefore (nor 
would it comport with the exact scope of Ms 
Theme), to propound, even through the use of 
Wine, a general and unconditional Cure : such 
depending not only on the idiosyncrasies of the 
Malady, but upon the divers stomachic fanta- 
sies, rheums, defluxions, humours, crudities, 
and assimilative vagaries of the Individual, as 

will 



Premonstration 

will be duly set forth in the following chapters. 
Forasmuch as no two leaves are precisely alike, 
nay, no two grains of sand resemble each other, 
so likewise no two Gouts are of identical habit 
and complexion. 

And of those who affirm that Wine engender- 
ed it, how many be there who rightly compre- 
hend the proper governing and Virtues of Wines, 
how wisely to choose and fitly to make use of 
them, — 

Hor. lib. i, Siccis omnia nam dura deus proposuit, neque 

Od. i8, 3. Mordaces aliter diffugiunt sollicitudines, — 

To the lips of the dry does the godhead taint all with a taste 

of the sour, 
And only by wine are the troubles gnawing into the bosom 

dispersed, — 

since in those countries where it is most cus- 
tomarily employed, do we not find the disease to 
be both the less frequent and the more amenable ? 
For be it known that Physicke (from the time 
of Hippocrates to the Present) hath but served 
to foster and sharpen the Malady, rather than 

to 



Premonstration 

to mend it. Else wherefore with such glut of 
Physicians and store of Medicine, doth the gird 
of Gout still wherret and harass in such exceed- 
ing great degree ? Its gir dings pursue us upon 
our journeys and in our rooms, even into lonely 
places and business-marts. Nor doe hollow Montaigne, 
rocks, nor wearing of haire-shirts, nor contin- nesse? ' 
uall fastings rid us from them. And that it is 
a sickness brought about by feasting and intem- 
perance, do we not see to the contrary when 
Philosophers, Physicians, Counselors, Ambas- 
sadors, Grammar^School Masters, aye, Popes, 
Priests, Friars, and many of the Ecclesiastical 
profession are grievously smitten by it ? 

Yet is it that of those who in books and dis- 
courses have touched upon the Malady, Syden- 
ham hath shown himself most worthy of his Art 
(yea, chief-craftsman of such craft), whereby the 
use of Wine is sanctioned or condemned, as the 
writer is governed by prejudice or melted by 
sympathy. And if not in words, at least by 
their actions, say they for the most part with Dr. 

Purgon : 



Premonstration 
Moiiere. Le Purgon : J'ai a vous dire que je vous abandonne 

Malade 

imaginaire. \ vo t re mauvaise constitution, a l'intemperie de 
vos entrailles, a la corruption de votre sang, a 
l'acrete de votre bile, & a la feculence de vos 
humeurs. (I abandon you to your miserable 
constitution, to the inclemency of your vitals, 
to the corruption of your blood, to the acrid - 
ness of your bile, & to the leaven of your 
humours.) 

Lo, the burden of these their Doctrines and 
the inconstancies of their Opinions, with which 
they disport like unto a juggler with his blades. 
Some have avouched that Meats do provoke it, 
others that Meats be beneficial. Some have de- 
clared that all manner of Beers lead there- 
unto, others will have breadstuffs to be hurtful, 
while some do commend them; some hold sal- 
lets, asparagus, tomatoes, tubers, scarlet-run- 
ners, and other such like to be poisonous; 
others that all Fruit engendereth vapours and 
humours; others that much Sleep is baneful; 
some affirm the Hermodactyl hath some sullen, 

churlish 



Premonstration 

churlish conditions with it : others that of all 

herbs it alone hath power to soothe. 

Saith one, strawberries are to be shunned; 

saith another, they should be chosen; and the 

third, they are good when moderately enjoyed. 

The one affirmeth it to be beholden to Bacchus : 

the other to Ceres, and still another to Venus. 

No two hold to the same belief, and within their 

ranks is there ever wrangling and contention. 

The words of the wise are as goads, and as nails Eccies. xii. 

fastened by the masters of assemblies. Verily, 

use they their calling to harrow and perplex ; 

and proffer a cure but to effect a temporary 

hold-all, which profiteth chiefly themselves. The 

Chirurgeon's knife, likewise, and his love of 

operating, is he not fain to employ it on the 

smallest pretext ; and is it not oft in these latter 

days the bent and puissance of the specialist to 

render woman unwomanly ? 

'T is the Chirurgeon's praise and height of art, Herrick. 

Not to cut off, but cure the vicious part. Hesperides. 

To the same purpose might the opinion of an 

ancient Gallic philosopher be adjoined : The 

Arts 
xi 



Premonstration 

Montaigne. Arts that promise to keepe our body and minde 
ence. j n g 00 fi health promise much unto us ; but there- 
with there is none performeth lesse what they 
promise. 

And whereas it may he perceived in the read- 
ing of these Meditations how beneficent Wine may 
prove in the treatment of the Evil, yet must it be 
manifest in like manner what Artifice it requir- 
eth to prescribe the exact sort that will meet the 
individual Case. This the Patient, or leastwise 
some wittly-wary Medical Mentor needs must 
choose, elect, and adjudge for himself from the 
amass of species, varieties, and vintages : at the 
hazard of aggravating the dangers of the Disease 
withal, if the hind most effectual for a Remedy 
be at first unapprehended. For may we rarely 
attain to any good result without studious re- 
flection, or stress of toil ; and with the sweet 
must ever be mingled the bitter : — 

Ovid, Usque adeo nulla est sincera voluptas, 

Metam. 7. Sollicitumque aliquid laetis intervenit. 

Where is the pleasure marred by no alloy ? 
Some apprehension ever haunts our joy. 

Our 

xii 



Ovid, 



Premonstration 

Our troubles still pursue us : — 

Scilicet interdum miscentur tristia laetis, 
Nee populum toto pectore festa juvant. Fasti, 

Grief mingles with our mirth, when at its best, 
And robs our feasts of some part of their {est ! 

See we not constantly bow little understand- 
ing prevailetb in the election of Wines ; whether 
they be white or red, mantling or still, sharp or 
balsamic, tawney or deep-coloured, and long or 
quick to the taste : whether they be well-corn' 
plexioned full pleasant Malmseys ; fat Bastards 
or Allicants ; pale Sacks that have lain long ; 
Muskadine that is strong and of sweet scent ; 
nutty yellow Canaries ; or Rhenish of Elstertune 
or of Barabant : whether they be the river, or the 
mountain grey sorts of Champaign, in colour 
like unto a partridge's eye, and fashioned after 
the manner of that most worthy monk, Perignon ; 
the wines de Garde near Nuis and Chambertin of 
which Lewis the Fourteenth drank no other hind ; 
or Gascoine wines that be made in the Castles 
about Bourdeaux, of which Chateau Margouze and 

O'Brion 
xiii 



Premonstration 

O'Brion possess the most ambrosial flavour . And 
of these last, whether they be fair-hued, ruby- 
bright, pleasant at the Nose, and smelling of the 
Rose or Violet, rather than those that be deep-hued 
as the Amethyst and savour of the soil ; or such 
as have lost their colour as happeneth ofttimes to 
Burgundy and Claret wines, causing them to be- 
come mustulent and to drink faint. Tloere be 
divers other sorts, in the choosing of which the 
Physician may have part for the guidance and 
governance of Gout, as seemeth best to his judg- 
ment and understanding : as those white Gas- 
coine kinds, in colour like unto light Amber that 
are known as Graves, Saint-Cross of the Mount, 
and Between Two Seas, according to their dis- 
trict, whose properties are dry, cooling, and of 
a diuretic nature ; aye, whose very fragrance is 
cool. For that which most profiteth one, is oft 
most cloysome to another ; and in nought do we 
observe so great disparity and so contrary effects 
as in Wines. Some do cheer while others do 
grievously offend, in the same manner that 6b- 

taineth 



Premonstration 

taineth with certain smells and odours. And 
moreover what comporteth at one time may prove 
hurtful at another, according to the season, and 
the Mood of the Malady. 

Never are we alway of the same precise tem- 
per and fantasy, nor may we ever wisely hold to 
the self -same way. Neither may we truly learn 
what best beftteth us save by experience, and by 
the infixing of laws, each unto himself, for his 
proper profit and understanding. Age calleth 
for joys other than such as be meted out to 
Youth in his April's flower, and the march of 
Time doth alter the power of wonted things to 
allure, or to conduce to health and bodily wants. 
As we change in our reading of Books wherein 
those once fervently fondled do no longer fully 
satisfy and sei^e upon the mind, so our appetites 
waver and shift, and create new longings for the 
Body's need. And even as a weathervane doth 
vacillate and veer, and a stream turneth now 
to the right hand and now to the left, the while 
it glideth on its appointed course, so do ad- 
vancing 
xv 



Premonstration 

vancing years cause us to deviate from those 
paths we have erstwhile followed : 

Hor. Ars Multa ferunt anni venientes commoda secum, 

Poetica. Multa recedentes adimunt. 

Years, as they come, a host of blessings bring; 
A host of blessings, as they go, take wing. 

Yet needs must halms for all diseases exist 
in the manifold products of tht vegetable king- 
dom, do we but know how rightly to turn them 
to account, and seek we to avoid pernicious 
dainties which lead unto our ailments. 

Verily, Hippocrates hath written much con- 
cerning his Art ; and Galen, Sydenham, Cullen, 
and Garrod have shown great ^eal (albeit they 
have accomplished little) in search of a Wine to 
assuage the pangs of the Malady. But do as best 
heseemeth him, take what course he listeth, choose 
his simples as he may, the Physician often avail= 
eth little ; and per adventure fareth he best who 
boldly taheth the Evil in his own hands, and 
thereof himself prescribeth The Cure. 

G. H. E. 

SCHONBERG, ROCHESTER, 1897. 



SYLLABUS 

PAGE 

The Malady 3 

The Theory 37 

The Palliatives 69 

The Regimen 89 

The Proscribed Fluids 117 

The Quandary 171 

The Induction 191 

INDEX 195 



THE MALADY 



Meditations on Gout 
¥ 

THE MALADY 

It is a kinde of maladie a man must fight withall. 

Montaigne. 

OUT is so closely associated 
with the daily subsistence of 
civilised man, it is an evil of 
such frequent occurrence, ac- 
companied by consequences of 
so serious a character, that a 
somewhat extended resume of its history, aetiol- 
ogy, treatment, and aberrations may be of interest 
to the layman, by whom it is usually considered an 
infrequent malady, — the sequence of high-living 
and thorn in the rose of gastronomy, with many 
years of savoury dinners and fragrant vintages as 
its genesis and means of evolution. More or less 
allied to dyspepsia and kin to indigestion, it is, 
3 




Meditations on Gout 

nevertheless, a common affliction induced by 
widely varying causes, that since the days of the 
ancients has proved a weariness to the flesh and 
has yielded little to medication. 

And while dyspepsia may well claim more than 
a passing word in discussing the question of good- 
cheer or in alluding to stomachic derangements, 
it is with wine and alcoholic fluids more especially 
that Gout is concerned and calls for specific con- 
sideration. For dyspepsia, except in rare in- 
stances, or where it exists in connection with 
other gastric disturbances of long standing or in 
themselves of a remarkably obdurate character, 
generally submits to treatment; whereas Gout, 
when once established, is for the most part be- 
yond the means of permanent remedial control. 
Its prognosis presumably reads: Unfavourable 
as regards complete and favourable recovery ; l 
or, A permanent release from the disease is 
rarely to be hoped for. 11 Even under the 
most favourable circumstances, it usually remains 

1 Prof. H. Senator, Diseases of the Locomotive Apparatus. 

2 Prof. Adolf Strumpell, A Text Book of Medicine. 

4 



The Malady 

like the vase and the attar-of-roses. Or so, at 
any rate, it has remained up to the close of the 
nineteenth century. 

Of what is its nature, and of what is it con- 
stituted ? Is it generated from without, or is it 
fomented from within ; is it caused by over- 
ingestion, or insufficient elimination, or both ; is 
it renal, hepatic, or neurotic in its character ; or 
do all of these conditions play a part in the 
dyscrasia? How far are involuntary causes re- 
sponsible for its production, — causes independent 
of the individual, — and how far is man capable 
of palliating or averting the disease ? Thereon 
authorities disagree, and therein consist its idio- 
syncrasies. As no eye can detect the precise 
colour of the dragon-fly's wings as he darts in 
capricious flight and reflects the sunbeam from 
his irised mail, so no cunning of the analyst has 
been able to determine the true complexion of 
this protean disease, that has been handed down 
from times remote, and falls without warning 
upon the just and unjust still. 

No other malady, not strictly organic, has 
5 



Meditations on Gout 

baffled medical science to so great an extent, the 
doctors themselves being frequently among its 
chosen victims, with whom it often flourishes under 
the more plebeian title of "rheumatism." What 
the physicians do not know on the subject would 
fill a far more portly tome than what they do know ; 
and in studying this question in particular, one 
may appreciate to some degree what the frater- 
nity are compelled to combat in searching for 
light on obscure subjects. The disease may be 
palliated to a certain extent, but thus far all the 
painstaking researches of the sons of ^Escula- 
pius have failed to exorcise it; and once in its 
clutches, the victim may hope for no absolute 
enfranchisement here below. The old Greeks 
vainly tried to conquer it, and as far back as the 
reign of Augustus it was written, Toller e nodosam 
nescit medicina Podagram (Medicine cannot 
remove the knotty Gout). The very name, 
" Gout ! " has a ferocious ferine sound, like the 
growl of some remorseless monster ready to 
fasten upon his prey. No other painful disease 
receives so little sympathy. " The toothach, the 
6 



The Malady 

paine of the gowt, how grievous soever, because 
they kill not, who reckoneth them in the number 
of maladies ? " The sufferer from rheumatism is 
condoled with ; the victim of Gout is left to col- 
chicum and his own consolation. 

The disease was as well known in olden times 
as it is to-day; it was in fact more common 
among the old Romans than at present, when 
even with women it was of frequent occurrence. 
By the ancients it was looked upon as the 
daughter of Bacchus and Venus, a Greek epigram 
reading, "Of limb-relaxing Bacchus and limb- 
relaxing Venus is born a daughter, the limb-relax- 
ing Gout." An old Latin adage embodies a 
kindred idea, Bacchus pater, Venus mater, et Ira 
obstetrix Artlritides ; while an ancient German 
paraphrase of the Greek sentiment reads, — 

" Vinum der Vater, Coena die Mutter, 
Venus die Habamm', machen das Podagram." 

Lastly, Cowper, at a later day, cries from his 
"sofa," of — 

" — pangs arthritic, that infest the toe 
Of libertine excess." 

7 



Meditations on Gout 

It is essentially a disease of civilisation, being 
unknown among savage races, and rarely occur- 
ring among those who have exchanged a wild 
for a civilised life. 

It has been referred to by very many Greek 
and Roman writers, including the "Father of 
Medicine" Hippocrates, Ovid, Celsus, Seneca, 
Pliny, Martial, Dioscorides, Aretseus, and Galen. 
Horace, in the seventh Satire of the second book, 
tells of old Volanerius, a great diner-out, who 
was so afflicted with Gout in his fingers that he 
could not throw the dice, and hired a man by 
the day to cast for him. Lucian has devoted two 
dialogues to the subject, — Tragopodagra and 
Ocypus, — in each of which Gout is one of the 
personam, and to whom he assigns priests and 
ministers : — 

" Who does not know me, Gout the unconquered, goddess 

of all earthly ills ! 
Whom neither the vapour of incense may placate, 
Nor blood poured out on burning altars, 
Nor the temple glowing with the suspended gifts of riches, 
Whom neither Apollo, doctor of all gods celestial, 
Nor the son of Apollo, the most learned ./Esculapius, is 

able to expel." 



The Malady 

Indeed, its literature is abundant, both among 
ancient and modern writers; and colchicum was 
an incense offered it by Hippocrates and Galen, 
as well as at a later era by Sydenham and Watson. 
Who was the Dom Perignon to first discover the 
therapeutic virtues of the herb, has not been 
ascertained; and a monolith to the autumnal 
crocus — the hermodactyl and anima articulo- 
rum of antiquity — has therefore yet to be 
erected. Though comparatively little used until 
the latter part of the eighteenth century, it is 
known that its remedial properties were familiar 
to the herbalists and monks of the middle ages, 
that it was early employed by the Arabs as a 
specific for arthritic afflictions, and that its name 
was given it by the old Greeks, from Colchis in 
Asia Minor, — a country where it grew. 

From its being usually attributed to luxury 
and close familiarity with the rarer products of 
the vine, Gout is sometimes supposed by the 
uninitiated to be a rather desirable companion 
than otherwise, — the acquaintance with which 
confers a certain title of distinction upon the 
9 



Meditations on Gout 

possessor. This might hold good were it a 
necessary sequent of a faultless palate and the 
signet of a supreme judge of wine. But gas- 
tronomy and finesse of taste are often no aux- 
iliaries in its acquisition; it may be acquired 
by ordinary beer and beefsteak as readily as by 
Chdteaubriands and a well stocked wine-cellar. 
And, like Faust when he made a compact with 
Mephistopheles, Gout proves an equally rigorous 
task-master, who allows no turning back or re- 
nunciation of his allegiance. You may whistle 
him up readily, once his acquaintance has been 
made, but he obstinately refuses to be whistled 
down ; he remains your most steadfast friend 
in the sense that he will never desert you. He 
appears when your habits are already formed, 
and when therefore they have become extremely 
difficult to change. The corrective or preventive, 
accordingly, rests largely with physicians and 
parents, rather than with him who eventually 
is to prove the sufferer, — in their apprising 
and advising him of the foe that may be lying 
in ambush amid the sauces, the bottles, the 



The Malady 

sweets, and the flesh-pots. Then if the ava- 
lanche falls, tant pis — the victim alone will be 
to blame. But in numerous cases, as statistics 
prove, the sufferer has little choice in the matter, 
and must perforce pay the penalty of the errors 
of his forefathers, who sowed the wind and 
had the pleasure, while he reaps the whirlwind 
and counts the pain. The preventive and cure, 
moreover, are difficult in all cases. It is hard 
to whip the lethargically disposed into exercise, 
and equally difficult to restrain those who are 
naturally so inclined from the pleasures of the 
table. The lesson, therefore, usually comes by 
experience, the sternest of teachers ; and in the 
case of Gout, experience generally comes too 
late. 

In England, as compared with other countries, 
the malady was much more common during the 
three and four bottle days when Port was the 
staple liquid and great quantities of heavy viands 
were consumed ; though it is still more endemic 
as a heritage there to-day than elsewhere. 
One will recall Thomson's lines in The Castle 



Meditations on Gout 

of Indolence as especially pertinent to those 
times as well as to the characteristic torments 
of the seizure, — 

" The sleepless Gout here counts the crowing cocks, 
A wolf now gnaws him, now a serpent stings." 

Contrasted with a century ago in England, 
an increase in the numbers affected, but a miti- 
gation of the forms is noticeable, with these 
distinctions : a lessened frequency of the more 
severe manifestations, a milder type of the acute 
attack, and a greater predominance of conditions 
which may be described as " attenuations of 
Gout," or goutiness in which there may exist 
just enough of the articular trouble to identify 
their gouty origin and character. This change 
in type and severity may be attributed to the 
largely decreased consumption of heavy wines, 
notably Port ; to the fact that hygiene has been 
made far more of a study than formerly ; and 
that the enlightened advice of the physician has 
been better heeded. The advances of cookery 
in England, as well, have presumably not been 



The Malady 

without their good results. Notwithstanding 
all this, Gout remains remarkably prevalent and 
seemingly ineradicable in Great Britain. " Even 
the most critical observers," Ewart declares, " will 
probably agree in recognising not only an in- 
creased prevalence of gout and goutiness among 
the upper classes, but its wider extension to strata 
previously less affected." 1 

Hereditary predisposition, according to statis- 
tics, is accountable for the large majority of 
cases, Sir Charles Scudamore having computed 
322 instances with a derivative tendency among 
over 500 subjects ; while of 80 cases reported to 
a Commission of the French Academy, in 34 
the disease had been transmitted. Of these 
cases analysed by Scudamore with reference to 
age, in only 5 did the disease occur in persons 
under eighteen; in 142 cases the ages at the 
time of the first occurrence were between twenty 
and thirty years; in 194 cases, between thirty 
and forty; in 118, between forty and fifty; in 

1 Dr. William Ewart, Gout and Goutiness, and their 
Treatment. 

13 



Meditations on Gout 

38, between fifty and sixty; and in only 10 
cases, between sixty and sixty-six. In 34 1 out 
of these cases, one or both great toes were 
affected, to the exclusion of other joints; an 
average fully confirmed by Garrod. In those 
instances where Gout commences between 
twenty and thirty, it is usually inherited. It is 
further stated by Garrod that in some families 
the inherited tendency is so strong that all their 
members, whatever precautions they may adopt, 
suffer from Gout ; and in many English families 
it has been handed down from father to son for 
centuries ; the tendency being much more fre- 
quently derived from the father's than the 
mother's side. 

Sir Leicester Dedlock, in Bleak-House, rises be- 
fore one in strong confirmation of this statement, 
when his faithful ally pinions him by both legs 
in the old oak bed-chamber at Chesney Wold : 
" All the Dedlocks, in the direct male line, 
through a course of time during and beyond 
which the memory of man goeth not to the 
contrary, have had the gout. It has come down 
14 



The Malady 

through the illustrious line, like the plate, or the 
pictures, or the place in Lincolnshire. Hence Sir 
Leicester yields up his family legs to the family 
disorder, as if he held his name and fortune on 
that feudal tenure. He feels that for a Dedlock 
to be laid upon his back and spasmodically 
twitched and stabbed in his extremities, is a lib- 
erty taken somewhere ; but he thinks, ' We have 
all yielded to this; it belongs to us; it has for 
some hundreds of years been understood that we 
are not to make the vaults in the park interesting 
on more ignoble terms.' " 

Next to heredity, unquestionably the most im- 
portant element in the aetiology and initiation of 
the disease is the patient's own mode of life ; its 
development in this case being generally ascribed 
to luxury, an over-generous diet, and lack of 
adequate exercise ; together with a latent pro- 
clivity to the gouty diathesis, or a certain predis- 
position from various causes in the individual. 

A third and frequent factor is lead -poison- 
ing, it having been observed that type-setters, 
plumbers, house-painters, and workers in lead- 
J 5 



Meditations on Gout 

mills are particularly subject to the disease. This 
is far more the case in England than in foreign 
countries, and in London still more than in other 
cities of the kingdom, which leads to the belief 
that the disease is not so much the product of 
lead in itself as that the operation of certain 
gout-producing causes, less frequent elsewhere, is 
largely assisted by it. Its increased prevalence, 
particularly in the English metropolis, has ac- 
cordingly been ascribed to the London work- 
man's alimentation, — rather than to race or 
climatic conditions, — in which animal food, 
stout, and heavy ales figure to a large extent. It 
is noteworthy that in Scotland, Ireland, and the 
North, where spirits are much more freely used 
than stout and ale, Gout is far less common than 
in London and the South. 

Numerous other causes, apart from heredity 
and alimentation, may be instrumental in produc- 
ing or furthering the disease. Physical inertia, 
undue worry, taking cold, an accident to the foot 
or limb of a sensitive joint, a tight shoe, a sprain 
or strain, even sudden climatic changes and sud- 
16 



The Malady 

den changes of regimen, where the foundation 
for the malady is already laid, may incite an 
attack. Too violent exercise under similar con- 
ditions may likewise prove an exciting cause. 
Examples have occurred where bicycling has 
brought on a seizure, or where the use of the 
wheel has a tendency to irritate the part that has 
previously been affected, — a consequent which 
may be readily understood when it is considered 
how important a part the feet are called upon to 
perform in cycling. Excess of exercise, more- 
over, is attended with danger to the predisposed, 
inasmuch as it can suddenly increase the produc- 
tion of uric acid, the toxic properly of Gout, to 
such a degree that the kidneys are unable to 
excrete the amount produced. 

Apart from these auxiliary causes, Dr. Mere- 
deth Clymer's description of its pathology is 
most axiomatic and true : "A disordered diges- 
tion is the primum mobile of the whole train of 
morbid phenomena." Equally terse is John Ma- 
son Good's definition : " An entonic state of the 
vessels, joined with plethora, may be set down as 
17 



Meditations on Gout 

the predisposing cause to acquired gout." " I 
believe the pathology of it," says Thomas K. 
Chambers, " to be a slight flux of mucus, de- 
ficient gastric secretion, and yet a vigorous, 
sometimes even excessive appetite. Hence such 
persons have not that check of failing desire for 
food which makes the meals of other invalids 
moderate, and eat more than their imperfect gas- 
tric juice can digest." To these opinions may be 
added the conclusion of Dr. Frederick C. Shat- 
tuck : " The most commonly accepted view as to 
its nature is that it depends upon defective oxi- 
dation, which may be brought about in two ways, 
— either by the ingestion of more food than can 
be properly oxidised, or by the presence of such 
conditions that even a moderate supply of food 
cannot be worked up and undergo its proper 
transformations, — a theory that will account for 
gout among the poor as well as the rich." 

That it is not limited to the rich, and is not 
solely a patrician disease, has been abundantly 
proven. Friars who are fond of good living, 
butlers swollen with Burgundy, and dockmen 



The Malady 

plethoric with porter are cited as common ex- 
amples ; while not a few occur among the lower 
classes, with apparently no inciting cause. Like 
Horace's "pallida Mors," who knocks at lowly 
shed and regal tower, so Gout is confined to no 
classes or conditions, but occurs as an every -day 
malady. 

Cullen's treatise on the subject is full of sen- 
tentious observation ; and despite some of his 
fallacies, probably no nineteenth -century writer 
has presented its serological features more con- 
cisely than has he in these paragraphs : — 

" The occasional causes of the gout seem to 
be of two kinds: first, those which induce a 
plethoric state of the body; secondly, those 
which, in plethoric habits, induce a state of 
debility. 

" Of the first kind are a sedentary, indolent 
manner of life, a full diet of animal food, and 
the large use of wine or of other fermented 
liquors. These circumstances commonly pre- 
cede the disease. 

"Of the second kind of occasional causes 
19 



Meditations on Gout 

which induce debility are, excess in venery ; in- 
temperance in the use of intoxicating liquors; 
indigestion produced either by the quantity or 
quality of aliments ; much application to study 
or business; night -watching ; excessive evacua- 
tions ; the ceasing of usual labour ; the sudden 
change from a very full to a very spare diet ; the 
large use of acids and acescents ; and, lastly, cold 
applied to the lower extremities." * 

To briefly emphasise its most frequent causes, 
it may be said that the general tendency of eating 
too rapidly and of charging the stomach with 
more than it can properly digest, are among the 
most predisposing agents. These, in connection 
with insufficient exercise and respiration, a gener- 
ous use of flesh food and alcoholic beverages, as 
also sweets and acids, and perhaps a lack of tone 
in some of the gastric functions or the organs of 
elimination, causes mal-assimilation, which with 
some induces dyspepsia, and with others assumes 
the form of Gout. 

But although alcoholic beverages are a trench - 

1 First Lines of the Tractice of Physic (1777). 

20 



The Malady 

ant instrument in challenging and provoking 
Gout, very many cases occur where the disease 
is not in the least dependent upon spirituous 
fluids. Generally, in such examples the patients 
have full appetites and are large eaters of animal 
food. Other examples, however, occur where 
the subjects are light consumers of flesh food, 
and whose appetites are merely normal. Where 
the disease occurs in such instances, it is more 
often derivative than acquired ; as in the case of 
not a few women who have directly inherited the 
diathesis, and directly encouraged it through their 
fondness for pastry and sweets. That sweets, 
noticeably in the form of saccharine wines, are 
most pernicious, will require no argument. And 
despite the fact that all kinds of saccharine sub- 
stances are converted into a sugar known as glu- 
cose before they are assimilated and absorbed, 
yet the system refuses to countenance the glucose 
of commerce as a substitute for the natural form. 
It is for this reason that candies are especially ob- 
jectionable to the digestive organs, glucose being 
largely employed in their manufacture. In a bul- 



Meditations on Gout 

letin issued on " Foods and Food Adulterants " by 
the Department of Agriculture, it is stated that 
not a single sample of twenty-five candies ex- 
amined consisted of pure cane sugar, being all 
mixtures of cane sugar with commercial glucose, 
or starch, or both. 

To how great a degree a neurotic condition or 
temperament may influence the disease has been 
comparatively little dwelt upon. But when it is 
considered how many diseases are directly fur- 
thered by such a condition, like urticaria for ex- 
ample, with which Gout is often associated, it 
will be readily seen that a nervous habit may 
exercise a strong predisposing influence, and 
merit the astiological importance it is assigned by 
Sir Willoughby Wade : " The nervous system is 
largely concerned in all the phases of gout and 
of goutiness ; and probably it also influences 
their mysterious hereditary transmission." * " We 
may assume with Rendu," Ewart also observes, 
" that while the original fault lies with nutrition 
and with digestion, the nervous system has an 

1 On Gout as a Peripheral Neurosis (1893). 



The Malady 

undoubted influence on the metabolic exchanges 
and on assimilation, and that it also exercises a 
determining influence upon some of the acute 
phenomena. But there is no adequate proof that 
the nervous system is independently and pri- 
marily responsible for the production of gout. 
We must own, however, that the subtle me- 
chanism of these influences is still unexplained. 
It is no less mysterious than the mechanism 
by which the occurrence of a severe articular 
attack often frees the patient from his previous 
ill-health." 

As opposed to the charges of high-living and 
intemperance made by vegetarians, Grahamites, 
and intemperate tea and water devotees, it is 
time that Gout should be clearly defined for 
what it really is in very many instances, — a 
perverse, ungrateful, maleficent malady, that 
delights upon the slightest pretext in assaulting 
vulnerable humanity at the most unseasonable 
hours and inconvenient times ; an infliction that 
is especially prone to picket club-men, physi- 
cians, poets, and heads of official departments ; 
23 



Meditations on Gout 

a stomachic metabasis that in some indetermi- 
nable, underhanded way is occasionally connected 
with the moderate use of certain wines and 
malt-liquors, though these be otherwise of an 
innocuous character; a scourge that for the 
most part is beyond the prevention of the 
average sufferer who duly follows the laws of 
the decalogue and leads the customary life of 
civilisation ; an abnormal affliction depending 
in a marked degree upon constitutional tendency 
and normal instinct, as well as occupation, cli- 
mate, and various other abettors more or less 
impossible to circumvent ; and, lastly, a stealthy, 
rancorous, irascible, mordacious disorder, masked 
under many forms, that continues to defy the 
science, skill, and pharmacopoeia of the med- 
ical profession. It is the charlock of maladies, 
that may thrive in every soil and will not be 
eradicated, — the Wolf of diseases, with ensan- 
guined fangs and encarmined jowl, who refuses 
to be baited even with asafoetida. 

Selecting for its victims subjects of all tem- 
peraments and widely divergent conditions, it 
24 



The Malady 

attacks the comparatively young, the middle- 
aged, and the old ; it fastens upon the man of 
robust constitution equally with him of frail 
habit ; it invades the home of the scholar, and 
prisons Plutus in his bed. Cruel and relentless, 
it strikes the professor at his desk, the general 
in his camp, the judge upon his bench. Its 
poison comes by heritage, its venom lurks in 
the wine-cup, its seeds are sown at the gather- 
ings of good-cheer. Emperors and kings have 
known its power, doctors and surgeons felt its 
lance, pontiffs have groaned in its grasp; while 
the priest, the monk, and red -robed cardinal 
have roared with pain when crushed within its 
clamp of steel. Only woman is comparatively 
exempt from its inflictions, though she on her 
part is a greater sufferer from its more merci- 
less relative, capsular rheumatism or rheumatic 
gout. 1 

1 At vero (quod mihi aliisque licet, tarn fortunes quant 
ingenii dotibus mediocriter instructis, hoc morbo laborantibus 
solatio esse possit) ita vixerunt atque ita tandem mortem 
obierimt magni Reges, Dynastce exercituum classiumque, 
Duces, Philosophi, aliique, his similes hand pauci. Verbo 
25 



Meditations on Gout 

With respect to pathology, medical authorities 
are unanimous in pronouncing the characteristic 
feature of Gout, as distinguished from other 
affections of the locomotive apparatus, like rheu- 
matic gout and various forms of rheumatism, to 
consist in the periodicity of the gouty paroxysm. 
It may also induce numerous other derangements 
in the internal economy, which may assume either 
a periodic or a continuous type. These derange- 
ments may start from the onset, or they may, and 
more generally do, not occur until a series of 
attacks of regular Gout. Its first appearance in- 

dicam, articularis Jncce morbus (quod vix de quovis alio 
adfirmaveris) divites plures intermit quam pauperes, plures 
sapientes quam fatuos. — Sydenham, "Tractatus de Poda- 
gra et Hydrope" (1683). 

But indeed (and this may be comforting to me and others 
but little endowed with either money or brains who are 
afflicted with this disease) in this manner have lived, and 
in this manner have finally died, majestic Kings, Rulers, 
Generals, Philosophers, and Admirals, and many others 
of like rank. Briefly, I should assert that this Gout (and 
you can hardly affirm as much of any other malady) slays 
more of the Rich than the Poor, and rather the Wise than 
the Fool. — SYDENHAM, Treatise on Gout and Dropsy (1683). 
26 



The Malady 

variably occurs in the acute form, generally fol- 
lowed by a longer or shorter period of renewed 
health ; and not until the system has become 
undermined by repeated assaults or unless one be 
specially predisposed, does it merge into the 
chronic or atonic form, as also what are termed 
the retrocedent and aberrant forms. Although 
its manifestations are infinitely varied in all its 
types, in nearly three-fourths of the total number 
of examples the first attack is confined to the 
large joint or metatarso-phalangeal joint of one 
of the great toes; the left, according to Dr. 
Gairdner, being more often chosen than the 
right. Hence the term Podagra, or Gout of the 
foot ; as also Gonagra, that of the knee ; Chira- 
gra, the hand ; Omagra, the shoulder ; hchiagra, 
the hip ; and Rhachisagra, the invertebral joints. 
While death rarely occurs from the disease in 
its regular type, complete recovery is an anomaly ; 
the chronic form, however, with the various com- 
plications that frequently attend it, after a vari- 
able number of years usually becomes fatal. 
Spring and Autumn are the most common seasons 
27 



Meditations on Gout 

of incursion in all varieties of the malady. With 
Aries it ushers in the vernal equinox, and with 
Sagittarius proclaims the reign of frost and 
snow : — 

" — the fall of the leaf and the starting of the bud 

Are the seasons he loves by the door ; 
Then his blood begins to rouse, this Caliban I house, 
And it 's ' Wolf, wolf, wolf ! ' at the door." 

" The wherefore I know not " is the brief answer 
Dr. Trousseau makes to these its chosen times of 
visitation. The reason, indeed, seems as inex- 
plicable, physiologically, as that lame girls should 
invariably possess surpassingly lovely complexions. 
Not that it is thus condescending on the start, 
by any means, and that it insists upon a semi- 
yearly visit. Far from it ; it has plenty of patients 
to keep it from feeling lonely. To be so frequent 
a guest, it requires much petting on the part of 
the palate and stomach; and only after many 
months of waiting, which may even be extended 
to a period of two or three years, does it deign to 
pay its respects anew, and help to free the blood 
of its impurities with its stylet and its drill. After 



The Malady 

repeated seizures, if its admonitions be not 
heeded, it proceeds to pass from the toe to the 
knee-joint, the knuckles, and other portions of 
the body, where it leaves its grim souvenirs in 
the shape of certain petrifactions known as chalk- 
stones, which take place around and outside the 
joint, filling up the areolar tissue, and lying in 
general immediately beneath the skin. Thus 
where the disease continues to make progress, 
numerous joints become involved, several of which 
may be simultaneously affected, or affected dur- 
ing the same attack. Anchylosis in a painful 
form distorts the hands and fingers, together with 
implications of internal organs, or inflammations 
of tissues — permanent or periodic — other than 
those pertaining to the joints. In place of the 
foot, the stomach may be attacked, with distress- 
ing consequences to the entire system; or even 
the brain or heart may be seized upon, with death 
as the result. 

Besides the manifold varieties of Gout itself, all 
eager to charge upon one at the slightest provoca- 
tion, there exist numerous varieties of goutiness, 
29 



Meditations on Gout 

or conditions of imperfectly declared Gout, in 
which various functional derangements of a gen- 
eral nature, not necessarily associated with defined 
structural changes, are present and threatening. 
Having its seat in the stomach and preying upon 
the frailties of that organ, goutiness is to be sus- 
pected in nearly all manner of stomachic disturb- 
ances; and who may declare himself free from 
some form of mal-assimilation or of mal-elimina- 
tion? Goutiness may harbour in dyspepsia, it 
may lurk in indigestion, it may be present in 
flatulency, it may hover over many minor gastric 
disorders. So that in nearly every case of indi- 
gestion, biliousness, and stomach trouble, the 
subject may have cause to fear the evil, and justly 
surmise that the foe is already undermining, 
plotting, and making ready for the assault. 

Above all, where there is the least disposition to 
puffiness of the feet, or where the ankles, instep, 
great toe, or any portion of the lower extremities 
are sensitive, tender, or readily responsive to 
atmospheric influences, goutiness is to be mis- 
trusted, and the patient were wise to be instantly 
3° 



The Malady 

upon his guard. To be sure, it may be merely 
rheumatism that is indicated ; but rheumatism 
and Gout are often so closely allied that it is a 
very difficult matter to draw the distinction ; and 
one can ill afford to dally with any indications of 
goutiness, lest they develop into the greater evil. 
Abstinence and Carlsbad, at the start, are the 
safest means of mitigating the penalty of dining, 
and indulgence in strawberries and oat-meal. 
For it must be remembered that before Gout can 
appear, goutiness must be present, and that uric 
acid, the toxic property of Gout, already exists 
even in the normal condition of the blood. Man, 
therefore, is born with a distinct gouty tendency, 
aggravated through the dietetic misdeeds of his 
ancestors, and furthered by his own voluntary or 
involuntary lapses. In other words, the fire is in 
readiness, and awaits but the striking of the 
tinder. How, then, may one expect to escape, 
unless by constant vigilance and the most subtle 
discrimination in the choice of a doctor, as well 
as in the selection of foods and beverages ? 
That a person afflicted with Gout should 
31 



Meditations on Gout 

receive little sympathy, except from his physician 
or from his fellow-sufferers, is scarcely to be 
wondered at, in view of the opinion that the 
disease is a just punishment to the offender, — 
a case where " just disease to luxury succeeds." 
The very nature of the malady, at least to those 
who have it not, provokes a smile. To think 
that a bottle of wine or a truffled pate, or even 
a glass of beer, instead of being absorbed and 
eliminated by the system in the usual manner, 
should mine its way through the thighs, knees, 
calves, ankles, and instep, to explode at last in a 
fiery volcano in one's great toe, seems a mirth- 
provoking phenomenon to all but him who is 
immediately concerned. Almost equally strange, 
too, is the period selected by the visitant for its 
assault, — the silent watches of the night, when 
it rouses the victim from his slumbers, and the 
softest bed becomes a veritable rack of torture. 
The pains invariably come on inter canem et 
lupum, or that time when the dog has gone to 
sleep, and the wolf has started upon his noc- 
turnal rounds. They diminish towards dawn, — 
3 2 



The Malady 

sub galli cantu, at the crowing of the cock, as 
Sydenham has chronicled. In vain your moans 
of anguish as the awl, the gimlet, and probe of 
the Inquisitor are thrust into your very bone and 
marrow. You might as well implore mercy 
from the Iron Virgin of the Burg of Niirnberg, 
or seek flight if locked in the dungeon of Chillon. 
It reminds one of " The Red Wolf " of Carman : 

" In the dread 'one of the night I can hear him snuff the sill ; 
Then it 's ' Wolf, wolf, wolf ! ' at the door : 
His damned persistent bark, like a husky's in the dark, 
His ' Wolf, wolf, wolf ! ' at the door. 

' I have tried to rid the house of the mis-begotten spawn ; 

But he skulks like a shadow by my door, 
With the same uncanny glee as when he came to me 
With his first cry of ' Wolf 1 ' at my door. 

" But when the night is old, and the stars begin to fade, 
And silence walks the path by my door, 
Then is his dearest hour, his most unbridled power, 
And low comes his ' Wolf ! ' at the door. 

" I turn me in my sleep between the night and day, 
While dreams throng the yard at my door, 
In my strong soul aware of a grewsome terror there, 
Soon to knock with command at my door ! " * 

1 Bliss Carman, Behind the Arras. 
3 33 



Meditations on Gout 

It is unnecessary to describe more at length 
the pangs of the acute paroxysm, — nunc ten- 
sionem violentam vet ligamentorum dilacera- 
tionem, nunc morsum cams rodentis quandoque 
pressuram et coarctationem exprimens. All 
those who have experienced them assuredly 
need no memoranda to bring them vividly to 
mind. Those who have not may be referred to 
Sydenham's account, — a description founded on 
personal experience of life-long duration, and 
the most graphic that has yet appeared upon the 
subject. 



34 



THE THEORY 



THE THEORY. 



wBs 



The history of human opinion is scarcely anything more 
than the history of human errors. — Voltaire. 

AVING referred thus briefly 
to the history, aetiology, and 
pathology, the theory of the 
disorder is next to claim 
attention. By all, it is rec- 
ognised that when its dis- 
tinguishing features — the gouty deposits — 
already exist, there is present a morbid condi- 
tion of the blood and humours, a fact equally 
understood by the ancients. It remained for 
modern research to discover the precise nature 
of this poisonous element, when Wollaston 
(1797), Tennant, Fourcroy, and others traced it 
to an accumulation of uric acid in the system, — 
a uric-acid dyscrasia. About 1787-1793 Murray 
Forbes, noting the close connection between Gout 
and gravel, and the proneness of the disorder to 
37 



Meditations on Gout 

form concretions, attributed Gout to the presence 
of Lithisiac, or what has since been termed lithic 
or uric acid. To Wollaston, however, is generally 
attributed the discovery of the active poison. 

In 1848 Sir A. Garrod showed that in Gout 
the blood contains an excess of this element, 
and that its excretion by the kidneys is di- 
minished. Numerous investigations have been 
undertaken since then; but while many well 
established facts relating to this theory have 
occurred, we do not know why the normal chem- 
ical processes are disturbed, and are unable to 
explain the connection between the various 
phenomena observed. 1 It is concluded that in 
Gout there exists so large a disproportion be- 
tween the rate at which this acid is formed and 
that at which it is eliminated, as to cause it to 
accumulate in the blood to an extent beyond the 
solvent capacity of that fluid ; or else that the 
solvent power of the blood itself is, for some 
reason or other, diminished. 2 
Garrod is inclined to the former opinion, 
1 Prof. Adolph Strumpell. 2 Prof. H. Senator. 

38 



The Theory 

believing, in common with most of the faculty, 
that the action of the kidneys is disturbed at a 
very early period, thereby promoting' a surplus 
of uric acid in the blood. It is in the serum of 
the blood, he further states, that the chief devi- 
ation from the healthy standard is discovered, and 
in this portion it is not so much that the normal 
constituents are affected as that excretory sub- 
stances which should have been eliminated are 
retained, — an effect due to the imperfect action 
of certain of the excreting organs, more especially 
the kidneys. It is supposed by some that the 
spleen, if not at the bottom of the trouble, never- 
theless plays a very important role in the forma- 
tion of uric acid, in that it is liable to enlargement 
when the products of gastro-intestinal digestion 
are being absorbed; and consequently a corre- 
sponding increase is observable in the amount of 
this acid eliminated several hours after a meal. 

Yet excess of this morbid element is not all : 
disturbances of digestion in themselves contribut- 
ing to generate organic acids (lactic acid, volatile 
fatty acids) in abundance; and it is clear that 
39 



Meditations on Gout 

these acids, becoming absorbed, may diminish the 
alkalinity of the blood. 1 Over eating and drink- 
ing frequently cause undue production of other 
acids during digestion, which take the place of 
uric acid and prevent its elimination. 2 It would 
seem that during certain forms of disease, new 
poisons, which are extremely virulent in their ac- 
tion, are produced by modified chemical changes. 
It is probable that poisoning so induced is much 
more common than is generally supposed. 8 We 
neither know whether the uric acid diathesis be 
the primary and chief anomaly in Gout, and 
whether it be not accompanied by other and more 
important changes in the composition of the 
blood ; nor do we know the disturbances of nu- 
trition by which one of the constant products of 
normal nutrition, uric acid, is formed in excess. 4 
It is now conceded that acid, not necessarily 
uric, is responsible for a very large number of the 

i Prof. H. Senator. 
2 Dr. Frederick T. Roberts. 
8 Dr. Benjamin Ward Richardson. 
i Dr. Felix von Niemeyer. 
40 



The Theory 

derangements of health which are manifested in 
many different ways ; among which may be men- 
tioned neuralgia, headache, migraine, myalgia, 
dyspepsia, skin diseases, acute inflammation, arte- 
rial and renal diseases, and various lung and 
bowel troubles. 1 

But whatever the existing, immediate, or com- 
bined causes of the morbific influences may be, it 
is the general opinion that the malady is a direct 
result of this redundance in the arterial and venous 
channels of the system, either introduced from 
without or generated from within, which, not 
finding its natural exits to the degree that it 
should, becomes deposited as urate of soda in the 
affected tissues, just as in rheumatism an excess 
of lactic acid occurs. So far as the resemblance 
between Gout and rheumatism is concerned, the 
former is much more closely related to a dyspep- 
tic condition ; and while rheumatism first attacks 
the shoulders or elbows, Gout nearly always selects 
for its onset the ball of the foot. Nevertheless, 
according to Trousseau, there are many so-called 
1 Dr. Albert Harris Hoy. 
4i 



Meditations on Gout 

metastases of rheumatism which are nothing else 
than metastases of Gout ; * or, as Flint expresses 
it, Gout and rheumatism may be said to belong to 
the same family, but each has a separate indivi- 
duality. 2 By some authorities, including Charcot 
and Haig, an arthritic diathesis is believed in, 
equally predisposing to either, the event being 
determined in each instance by the special circum- 
stances of the attack. Indeed, Hutchinson ex- 
presses the opinion that Gout is but rarely of pure 
breed, and often a complication of rheumatism. 
It so often mixes itself up with rheumatism, and 
the two in hereditary transmission become so in- 
timately united that it is a matter of considerable 
difficulty to ascertain how far rheumatism pure 
can go. 8 Rendu is of the opinion that acute 
Gout in the joints is, like acute rheumatic arthri- 
tis, often traceable to an impression of cold, and 
that this must operate through some nervous en- 

1 Dr. A. Trousseau, Lectures on Clinical Medicine. 

2 Dr. Austin Flint, A Treatise on the Principles and Prac- 
tice of Medicine. 

3 Dr. J. Hutchinson, Pedigree of Disease. 

42 



The Theory 

ergy. Rheumatism more often assails the poor, 
and Gout the well-to-do. Both conditions are the 
products of fermentation, and may be the sequel 
of a hyper-production, or of a diminished elimi- 
nation, — the prevailing belief being that it is more 
the result of defective elimination than of over- 
production. Both are acid diseases, marked by 
changes in the alkalinity of the blood ; both are 
frequently hereditary ; and the dietetic regulations 
to be observed in their treatment are virtually the 
same. 

Briefly summarised, it may be said that ac- 
quired Gout, and very often the transmitted 
form, are caused by the ingestion of food or 
fluids or both, to a greater extent than the elimi- 
nating capacities of the system can provide for, — 
whether this lack of elimination be the result of 
a deficiency in some of the excreting organs, or 
the consequence of a surplusage of nourishment. 
Finally, the diathesis may also be induced by an 
inadequacy of gastric secretion to perform the 
proper functions of digestion, or too rapid eating 
which acts as an equally disturbing elements 
43 



Meditations on Gout 

" We recognise that Gout does not take its gene- 
sis solely in port wine and gluttony," but on the 
contrary may have its origin in many causes the 
exact nature of which is often a puzzle to the diag- 
nostician. For a concise summary of the uric 
acid diathesis as viewed by various authorities, 
the reader may be referred with advantage to a 
small volume by Dr. F. Levison of Copenhagen. 1 
A table of statistics of Gout compiled from the 
different countries of the world, were it obtain- 
able, might diffuse some interesting light on the 
theme. Next to England, Holland is said to be 
most subject to the malady ; the Dutchman being 
an excellent connoisseur of wine, as well as of 
Schnapps and " blue and white." No doubt the 
dampness of the Netherlands is also a promoter. 
Gout, as already stated, is quite common in cer- 
tain portions of Germany, more so in Bavaria 
than others ; a fact in which climatic conditions 
— sudden changes induced by the close proximity 
of the Alps and the Bohmer Wald — may play 

1 The Uric Acid Diathesis, Gout, Sand and Gravel (Lon- 
don, 1894). 

44 



The Theory 

a part ; but for which malt liquor must be held 
principally responsible. Yet when one considers 
the enormous quantity of beer consumed in 
Germany, the rivers of Hof, Fran^iskaner , 
Augustiner, Pschorr, Erlanger, Wurtqburger, 
Nurnberger, Augsburger, Pilsener, and Braus 
innumerable that are hourly poured by the Maas 
and litre down the throats of thirsty millions, it 
would seem that this agent is far less deleterious 
there than in other countries, — an assumption 
that would point to the much more wholesome 
and finished quality of the national beverage, or 
to its better combination with the customary ali- 
mentation, or to both conditions. 

The excellence of German beer is proverbial ; 
the quality of hops and malt and water, the slight 
amount of alcohol it contains, and its absolute 
purity. Certainly there is no comparison be- 
tween the light, refreshing brews of Germany as 
drunk upon the spot — beverages adapted solely 
for rapid consumption — and the heady, heavy 
beers and bitter pale ales of Great Britain, or the 
adulterated products of the United States. It is 
45 



Meditations on Gout 

well known that many among the poorer classes of 
Germany subsist largely upon bread and beer, or 
more correctly speaking, upon beer and bread, and 
that the national beverage is generously given to 
children from infancy, with no qualms of a future 
uric-acid diathesis. Racial conditions would hardly 
seem to enter as a qualifying component, unless 
it is that the Germans are more prone to lead an 
out-of-door life than the English ; for the Teuton, 
though extremely fond of greens and vegetables, 
is a large consumer of meat in the form of veal, 
pork, and sausages; and with the exception of 
his leisurely Spa^iergangs or walks that Schiller 
extols, does not follow outside sports as vigor- 
ously as do many other nationalities. But he has 
only to enter one of his attractive beer-gardens to 
find himself virtually out-of-doors, and to enjoy 
with " Lust " the " freie Luft," and his cool, 
foaming glass. Here amid genial companion- 
ship and the cadences of dulcet strings and reeds, 
he may scatter care to the winds, and with no 
thought of life's ailments join in the joyous re- 
frain of Der Wildschut^ : — 
46 



The Theory 

Heiterkeit und Frohlichkeit, 

Ihr Cotter dieses Lebens, 
Ench {u sehen, \u erflehen, 

1st das Ziel des Strebens ! 

The argument advanced by wine-drinkers, that 
in those countries where wine is largely con- 
sumed, Gout is seldom met with, requires to be 
taken with considerable allowance. Relatively, 
this is the case. But while it is true that, in pro- 
portion to the amount consumed, most wine 
countries are comparatively free from the malady, 
it by no means follows that they are exempt 
from Gout, gravel, and diabetes. In a certain 
measure the same hygienic and dietetic conditions 
hold good for all. Thus the Parsees of India who 
are great meat-eaters are afflicted with Gout, 
which very rarely occurs in tropical climates. 
And in France the gourmet and wine-drinker 
who leads a more or less sedentary life, does not 
escape the penalty, even in Bordeaux where he 
may drink the lightest of French wine at the 
fountain-head. Of late years diabetes has in- 
creased largely in France. Among the luxurious 
47 



Meditations on Gout 

class, and in Bordeaux perhaps more than in other 
places in the republic, this disease has become ex- 
tremely common, as stated by Dr. Carles, the 
well-known local Professor of the Faculty of 
Medicine. " The Bordelais," he says, " is by 
nature and his environment extremely fond not 
only of good wines, but also of the fine dishes 
with which they are injuriously accompanied. 
As the nature of his business, in addition, neces- 
sitates a sedentary life and constant preoccupa- 
tion, he finds himself more than otherwise afflicted 
with diabetes, gout, and kindred maladies com- 
mon to the well-to-do." 1 

Considered from the standpoint of the experi- 
ence of various countries, it again appears that 
food and drink, luxury, temperament, climate, 
hereditary disposition, insufficient oxygenation 
and out-of-door exercise ; or in many instances, 
to speak more truly, a combination of some of 
these conditions, are the fundamental elements 
that incite and develop the disease ; and that 
while extremely protean in its forms and the con- 

1 Dr. P. Carles, Le Pain des Didbetiques. 
48 



The Theory 

ditions which induce it, it everywhere owes its 
origin to causes more or less alike, within or 
without the control of the individual, and within 
or without the power of the physician to remedy. 
It may yet be queried, on the other hand, how 
far various local and racial conditions may enter 
as mitigating or operative agents. The relative 
health of nations, the question of natural tem- 
perament, climate, occupations, diversions, and 
general mode of life, are factors to be considered. 
Were the phlegmatic Teuton to give up his 
Gerstensaft and devote himself to the consump- 
tion of Haut-Me'doc, or were the impressible Gaul 
to accompany his entrees with Munchner, the 
arthritic result might be painful to contemplate ; 
the fate of nations depending not only " upon 
what they are fed," but in equal measure upon 
the congruous liquid accompaniment of their 
food. No one has yet called attention to the fact 
that woman may be instrumental in the evolu- 
tion of the malady. Had Eve never tempted 
Adam with a raw sub-acid fruit ; did Circe not 
constantly tender the " wine-cup " which she is 
4 49 



Meditations on Gout 

credited with presenting ; were women not so 
gluttonous of sweets, and consequently largely 
responsible in developing and transmitting a uric- 
acid diathesis ; had Bacchus no attendant nymphs 
to replenish his chalice — all might be different ! 
It will be readily apparent, therefore, that the 
subject of Gout — its subtle causes and its remedy 
— does not enter so much in the domain of the 
physician as in the province of the pantologist, 
metaphysician, and philosopher ; and in place of 
the Sydenhams and Garrods, should be turned 
over to such minds as Goethe, Schopenhauer, 
and Spencer for its true elucidation. 

Man proverbially eats more than he can prop- 
erly assimilate; and leaving the stronger wines 
and heavy malt-liquors out of the question, the 
disease would appear to be generated fully as 
much from food as from alcoholic fluids ; heavy 
viands being certainly one of its most active 
operating agents. Although France is noted for 
the excellence of its cuisine as well as for its 
large consumption of wine, Gout prevails to a 
very much less extent there than in England. 
5° 



The Theory 

The same is true of Germany compared to the 
latter country. This fact may be due to a plural- 
ity of reasons. Firstly, through a less strong 
hereditary tendency influenced primarily by Port 
and heavy ales; secondly, through the lesser 
consumption of animal foods, and the use of a 
more mixed diet ; thirdly, to the lighter and 
superior cookery ; fourthly, to the skilful use of 
herbs and seasonings in cooking, which, judi- 
ciously employed, stimulate the gastric secretions 
and facilitate digestion ; and, lastly, to the pleas- 
ing variety of aliments, and the custom of serving 
them in dainty limited courses which renders 
rapid eating virtually a tour de force. In this 
manner, especially as the meals are accompanied 
by a light, refreshing wine, the palate is pleased 
and the stomach is less fatigued. " In our case," 
says the Frenchman, addressing the Englishman, 
we have ' gout ' for the taste ; in your case, you 
have ' gout ' for the result." 

Among the labouring classes and less well-to- 
do classes of the provinces where much wine or 
cider, and some beer is consumed, the diet is 
5i 



Meditations on Gout 

necessarily plain; but the wines, whether white 
or red, are always wholesome and never over- 
rich. Of late years Gout has become much more 
prevalent in the Eastern and Middle States of 
America than formerly, from the same main 
reasons that induce it in other countries. Ameri- 
can beer, very much of which is far from being 
confined to hops and malt and water, has been 
assigned by many physicians a foremost place 
as a promoter of the malady. " The question 
of the adulteration of beer, in this country at 
least," says Dr. Hoy, " is one the importance of 
which can scarcely be overestimated. Any physi- 
cian who has had occasion to prescribe American 
beer must have been struck with its proneness to 
cause fermentation and gastric disturbance, while 
the use of imported beer is not followed by these 
results. The enormous consumption of -glucose 
and powdered rice by brewers is a sufficient com- 
mentary on the purity of their goods." x 

That vigorous exercise in the open air alone, 
when other strong inciting causes exist, is not a 

1 Dr. Albert Harris Hoy, Eating and Drinking. 
52 



The Theory 

sure preventive is apparent when one considers 
the case of England, where all forms of out-of- 
door sports are more in vogue than in any other 
country. " A man is a doctor or a fool at forty," 
saith a Spanish adage. But govern himself as he 
may, within reasonable bounds, if his tempera- 
ment be strongly predisposed, he will always find 
it a difficult matter to forefend the uric-acid 
diathesis, which has generally commenced its sub- 
tle inroads long before the fifth decade. Never- 
theless, sufficient stress cannot be laid upon the 
importance of exercise, oxygen, and sunlight, as 
combined in an open-air life or a number of 
hours spent every day out-of-doors, in the direct 
tonical effect upon the general health, and thus in 
the direct benefit to digestion and assimilation. 

Some mode of attaining the advantages of this 
form of hygiene should be sought by all those 
whose occupations are of a confining or sedentary 
character. The writer, the scholar, the lawyer, 
the business-man, each and all, should have their 
recreations that will lead them out-of-doors. 
They should be familiar with Walton and White, 
53 



Meditations on Gout 

Thoreau and Jefferies, in order to attain a fuller 
understanding of the delights and resources of 
Nature, even if they forego Hugh Miller, and 
"The Prelude" of Wordsworth. Nature stands 
smiling without, the same year by year, as each 
season proffers its countless charms. And to 
commune closely with her, if not always an anti- 
dote, is at any rate a prophylactic of great value 
in many disorders that molest mankind. Well 
for him who knows and loves her truly, and who 
may himself exemplify the poet's lines : — 

" The meanest floweret of the vale, 
The simplest note that swells the gale, 
The common sun, the air, the skies, 
To him are opening paradise." 

To prescribe simply a certain number of miles 
in daily walks does not answer. This manner of 
exercise without a purpose, or rather a pleasure, 
connected with it, soon becomes irksome, and the 
walks gradually become shorter or are for the 
most part discontinued. One requires an in- 
centive, — the rod to spur him to the waterside, 
the gun to open up the covers, the love of the 
54 



The Theory 

botanist, ornithologist, or entomologist to draw 
him to the fields and woods. Or it may be 
equestrian exercise, the golf link, or the wheel, — 
any diversion that will lead one into the open air. 
It is patent to all that the function of respiration 
is a double one, a sort of " give and take " affair, 
— receiving oxygen, and bartering therefor car- 
bonic acid, precisely the reverse of what takes 
place in vegetation. It is easily deduced that re- 
tention of carbonic acid in the system is highly 
deleterious, even poisonous, and that its ex- 
pulsion through the air passages, and its replace- 
ment by oxygen, is vital. Oxygenation of blood 
is revivifying, and furthers, directly and indirectly, 
all vital processes in the way of tissue-building, 
and activity of all emunctory organs; that is, 
elimination of effete matters from the body. To 
inhale as much pure air as possible, and check the 
retention of carbonic acid in the system, is a sine 
qua non in the treatment of many diseased con- 
ditions, and this applies to Gout par excellence. 
Thus it may be affirmed that whatever tends 
to the general health helps to prevent and expel 
55 



Meditations on Gout 

disease ; and hence open-air exercise, through in- 
creased respiration, cutaneous elimination, and its 
invigorating effects upon the appetite and digestive 
organs, becomes of signal importance in Gout. 

Between Gout and dyspepsia, it has already 
been noted, there are certain features in com- 
mon; though were one of the two maladies to 
be chosen, except where Gout assumes the 
chronic form, Gout would seem to be the lesser 
evil. Little is heard of Gout compared to the 
harrowing plaint of the confirmed dyspeptic, 
whose sufferings are written in every lineament. 
No wonder that Carlyle was vituperative and 
constantly showing his teeth. To quote his 
own words, "the accursed hag dyspepsia had 
got him bitted and bridled, and was ever striv- 
ing to make his living walking day a thing of 
ghastly nightmare." But though in a certain 
sense the diseases are so dissimilar, they yet have 
many traits in common. " The more closely I 
have thought upon gout," Sydenham has stated, 
"the more I have referred it to indigestion." 
Each has its seat in the stomach or in the intes- 
56 



The Theory 

tinal digestive tract, and each is the result of 
perverted assimilation. But the one, while ex- 
cruciatingly painful for the time, is intermittent, 
whereas the other is more or less unintermitting ; 
and Gout, except in hereditary examples, rarely 
occurs during early youth. 

Stomachic disturbances such as flatulency, 
gastric fermentation, constipation, and the like, 
are almost always an accompaniment of each. 
Rich indeed is he, therefore, who has inherited 
and maintained a good digestion ; for the 
stomach is the great seat and dispenser of joy, 
and one of the first requisites to sound health, 
without which all other joys must pale. But 
with the abuse that is so often heaped upon it 
by both the knowing and unknowing, the 
wonder is that it submits with half the grace it 
does; and like the harp that Watts sings of in 
the well-known hymn, strange it is that its 

" — thousand strings 
Should keep in tune so long." 

Perfect health, which is above riches and for 
which riches often strives in vain, is seldom 

57 



Meditations on Gout 

maintained throughout life, and is oftener a 
heritage of those whose lot compels them to 
expend bodily exertion and manual labour in 
the attainment of their daily needs than of those 
who bask in affluence or live in luxurious ease. 

Riches proverbially begets its ills ; and poverty, 
as distinguished from indigence and want, even 
if it have its thorns, is not altogether without its 
roses in that it is a preventive of many diseases 
that wealth invites. One is not apt to miss that 
with which he is unfamiliar ; and the frugal fare 
of the labourer, earned by the expenditure of his 
muscle and his brawn, may, after all, possess a 
keener relish than the highly seasoned dishes of 
the epicure. 1 And as one must earnestly have 
coveted " that whereof he would enjoy an absolute 
delight," so it is one of Nature's laws that one 
must earn his physical well-being and the pleas- 

1 Many rich men, I dare boldly say it, that lie on down- 
beds, with delicacies pampered every day, in their well- 
furnished houses, live at less heart's ease, with more 
anguish, more bodily pain, and through their intemper- 
ance more bitter hours, than many a prisoner or galley- 
slave. ( The Anatomy of Melancholy.) 
58 



The Theory 

ure of living by some disbursement of physical 
exercise or physical toil. 

As to the prognosis of the malady, it may be 
of comfort to some to know that concerning the 
individual paroxysm the following indications 
may be considered favourable: the limitation 
to few joints, or, better still, to one joint only, 
especially if that joint be a toe ; acute fever, 
severe local inflammation, with great pain ; strict 
periodicity of occurrence. The more marked 
all these features, the better is the prospect of 
unbroken health to follow the attack, and the 
longer may the period be expected to last. In 
other words the disease will be less apt to assume 
a chronic form, or end in chalk-stones and an 
attack upon the stomach and the heart. The 
prognosis of hereditary Gout is usually less 
hopeful than that of the acquired disease, the 
former being more obstinate and more prone to 
pass into the irregular variety. 1 Among other 
schedules, Richardson has presented the following 

i Prof. H. Senator, Diseases of the Locomotive Appa- 
ratus. 

59 



Meditations on Gout 

table relating to the periods of mortality in gen- 
eral diseases of constitutional type : — 

London. GOUT. 

Maximum. Middle of March to end of April. 

Minimum. Beginning of June to end of year; absolute, 
September. A large increase takes place in 
last week in year. Another in middle of 
March ushering in annual maximum. 1 

Sydenham and Cullen have maintained that 
the disease is incurable, holding to the doctrine 
of non-interference, and " patience and flannel." 
"As for a radical cure," Sydenham declares, 
" one altogether perfect, and one whereby the 
patient might be freed from even the disposition 
to the disease — this lies, like Truth, at the bot- 
tom of a well ; and so deep is it in the inner- 
most recesses of nature, that I know not when 
or by whom it will be brought forward into the 
light of day." Garrod believes that Gout in 
its acute form is as controllable as any other 
inflammatory affection, and that chronic Gout 
may be relieved to the extent of enabling the 

1 Benjamin Ward Richardson, The Field of Disease. 
60 



The Theory 

patient to enjoy life. Ewing, and some others, 
lean to a similar opinion. " Prior to its earliest 
warnings and for some time afterwards," says 
Ewing, " the remedy is in our own hands ; an 
active and frugal life is a safe preventive, and 
may often be a cure." 

In brief, by entirely changing one's mode of 
life and dietary, the disease may be possibly 
prevented if taken in its initial stages, and un- 
doubtedly checked to a considerable extent in 
many of its later periods. A dullard may be- 
come rich by avoiding nearly all disbursements 
and pinching himself to the verge of starvation ; 
nearly all is possible to persistent and rigid 
denial. One may also combat Gout on similar 
terms, and escape with a few flesh wounds. By 
converting the dinner into a frugal lunch or still 
more frugal supper, together with the leading of 
an open-air life, and the abstention from all 
alcoholic beverages, there is no doubt that Gout 
may be kept within reasonable bounds. Per con- 
tra, it may be said that life is worth living, and 
that there are things which are so good in them- 
61 



Meditations on Gout 

selves that they are cheaply purchased by a little 
malady, if not by a little mortality. And of fret 
and cark and tribulation, to nearly every one is 
meted out his share. Life is short at its longest, 
and, after all, Omar's philosophy has a soothing 
sound : — 

" Ah, fill the cup ! What boots it to repeat 
How time is slipping underneath our feet ? 
Unborn To-morrow and dead Yesterday, 
Why fret about them if To-Day be sweet ? " 

But all the wise and weighty observations of 
the sages, buried as they are in ponderous tomes 
in the terra incognita of the doctor's shelves, 
are mostly unknown and inaccessible to the lay- 
man in whom the seeds of the disease may 
be lurking or already germinating. And thus, 
unwarned and unarmed, knowing no more of 
the malady than that it has occurred to others, 
in entire unconsciousness of what the future holds 
in store, the rap of the Inquisitor comes, and the 
demon enters one's sleeping-chamber to claim 
him for his own. Were physicians true philan- 
thropists, they would early warn such of their 
62 



The Theory 

patients as they considered in the category of 
"suspects," of the dangers and inconveniencies 
of the disease, even to placing Sydenham's 
monograph of the subject in their hands. Or, 
certainly, upon a first attack, they would thor- 
oughly apprise, exhort, and instruct them re- 
garding the coming events that already cast their 
shadows before. They should at once acquaint 
themselves with the foibles of their patient, — his 
hours and habits, his pet tipples and favourite 
dishes and sauces, even to demanding the open 
sesame of his wine-cellar, in order to ferret out 
the liquid offender. 

Yet through the neglect of their bodily ad- 
visers who merely apply a temporary balm, the 
sufferer does not realise the seriousness of the 
evil until it has advanced to such an extent that 
remedies are of slight avail. Beyond certain 
stomachic disturbances of a more strongly 
marked character than usual, the patient has 
little warning of the first seizure; and this 
warning he knows not how to interpret aright. 
The advances are stealthy and insidious, and not j 

63 



Meditations on Gout 

of a nature to excite alarm. Were the first 
excesses or carelessness to visit the offender in 
a mild form of retribution; or were there a 
pronounced caution — a loud whistle of danger 
ahead ! for pains and penalties that are to follow, 
he would at once begin the work of reformation, 
and hasten to make terms with his stomach at 
whatever cost. 

Yet some there are who after having expe- 
rienced a first seizure, may presage a threatened 
attack by certain well-defined indices, — like 
those portents in the sky that herald the ap- 
proaching storm. The low growl of the thunder 
is heard ere the lightning's shaft descends. Wise 
is he who heeds the admonition, and adopts 
heroic measures to avoid the crisis if he can. 
Previous to an attack, as already observed, there 
is frequently indigestion of some standing, ac- 
companied by acidity and a furred tongue; 
together with other premonitory signs, espe- 
daily disturbances of the nervous system with 
which the malady is frequently closely allied. 
The appetite is capricious, the muscles may be- 
64 



The Theory 

come cramped in the lower extremities and calves 
of the leg, sleep is not sound, tobacco loses its 
flavour, and wine its bouquet. The physical 
functions become more or less dulled, there is 
an inaptitude for intellectual labour, and the 
system lacks in elasticity and tone. These, one 
and all, are the mares' -tails, streamers, mackerel- 
clouds and primrose-bands that point to the im- 
pending change. Among the infinite peculiarities 
of the malady, none, perhaps, is more strange 
than the hearty appetite and minutely fine ap- 
preciation of the bouquet and savour of wines 
which often immediately precede an attack, after 
a period of capricious or failing appetite, and 
more or less obtuse discrimination of customary 
food. The golden or terra-cotta rim of a glass 
of ripe Bordeaux then stands out with redoubled 
salience, and the juices of Pessac appear trebled 
in perfume and vinosity. The appetite is keen 
and discerning, and the bodily senses remarkably 
acute, — just as an old Eastern rug, under certain 
peculiar conditions, may leap into a new maze 
of unaccustomed hues. 
S 65 



THE PALLIATIVES 




THE PALLIATIVES 

Is there no hope ?' the sick man said; 

The silent doctor shook his head. 

Gay. 

HE herculean task undertaken 
by Count Grammont, to shake 
off his former charmer, the 
\rusee Mile. Saint Germain, 
I and hoodwink his friend Matta, 
to placate the wily Marquis' 
de Senantes, and capture the voluptuous Mar- 
chioness, was as nought compared to devising 
a prescription that will effectually propitiate 
Gout. The finesse of the Count, in the end, 
was equal to the emergency ; the physician still 
remains in fruitless quest. 

Of the numerous remedial agents employed 
to mitigate the pains of the disease, colchi- 
cum stands first and foremost, having proved 
the most efficacious anodyne, not only in the 



Meditations on Gout 

paroxysm, but in numerous stages of numerous 
forms of the disorder. Its every part and portion 
is precious, — the corm, the seeds, and the clus- 
tered rosy-purple flowers. From time imme- 
morial it has been considered the great antidote 
to the materies morbi, although when taken in 
considerable quantities, it produces nausea, faint- 
ness, and diarrhoea, is injurious to the coating of 
the stomach, and liable to produce inflammation of 
the viscera. So, while a powerful, it is none the 
less a dangerous remedy in injudicious hands, — a 
fact duly recognised by old Gerarde, who thus 
refers to it in his Great Herb all : " The roots of 
Hermodactyls are of force to purge and are prop- 
erly given to those that have the Gout. The 
roots of all the sorts of Mede Saffrons are very 
hurtful to the stomache." 

Precisely how it acts is not known ; but that it 
does act, and sometimes with wondrous efficacy, 
is beyond contradiction. Still, medical writers, 
while sanctioning the use of colchicum, yet cau- 
tion that it be very carefully employed ; and of 
such not a few condemn its use until the attack is 
70 



The Palliatives 

well under way; it being thought the sudden 
checking of an acute attack, or attempting to 
ward it off through powerful medicines, may de- 
feat the efforts of Nature to eliminate the poison, 
thus leading to changes in the vessels and internal 
organs, and inducing the malady to assume the 
chronic form. " At the commencement of my 
practice," observes Trousseau, " I attempted to 
fight with the disease ; now I cross my arms and 
look on ; I do nothing, absolutely nothing, to 
subdue attacks of acute gout." 

Iodine, sulphur, arsenic, and mercury have been 
employed with varying success as alteratives, 
notably in constitutional Gout and goutiness; 
and while none of them are specifics for the 
disease, they have all been found of benefit. In 
sub-acute and chronic cases, cinchona and its 
alkaloids have been used with excellent therapeuti- 
cal results; as also nux vomica and strychnine, 
due regard being had to individual nervous pecul- 
iarities, and to the degree of renal efficiency. 
Iron has been pronounced one of the most diffi- 
cult remedies to prescribe with success, its 
7i 



Meditations on Gout 

untimely administration almost inevitably deter- 
mining a fresh paroxysm. 

Of other agents employed in combating the 
dyscrasia, are the salts of lithia, a powerful sol- 
vent first proposed by Garrod ; together with the 
liberal use of alkalies, the carbonates and com- 
pounds of potash and soda, with the vegetable 
acids, lime-water, and magnesia. It is the general 
opinion that lithia is best when administered in 
fluid form, or if the tablets be employed, that 
they be taken with liberal supplies of water, and 
preferably at least an hour before meals. All 
these are employed as solvents to induce as far 
as possible an alkaline condition of the blood, 
which even in its natural state always contains 
a certain amount of uric acid. 

Large draughts of plain cold water are advised 
by some as "flushers" to the system. Others 
recommend various forms of mineral waters, ac- 
cording to individual cases. These, says Professor 
Senator, principally tend to remove the various 
disorders which stand in a more or less close 
degree of causal relationship to Gout, either as 
72 



The Palliatives 

antecedents or concomitants. To introduce the 
desirable quantity of lithia into the system daily, 
from thirty to forty -five grains of the carbonate 
should be taken in combination with two to three 
quarts of water. Garrod specifies guaiacum, a 
compound made from the resin of Guaiacum 
officinale or Lignum-vitse tree of the West Indies, 
as a remedial agent which he has employed for 
years to great advantage, both in the cases of old 
subjects and young patients. Mention is also 
made by Professor Schultzen of a substance 
termed sarkosin that is unknown to the phar- 
macopoeia, the difficulty of its preparation and 
its high price having rendered it thus far pro- 
hibitive; this, he asserts, is a marvellous sol- 
vent, though he does not state its effect upon 
the digestion. 

Of late years guaiacum has become much bet- 
ter known than formerly, and now takes rank 
among the most efficacious active remedies in 
chronic Gout. So highly is it considered by 
Garrod that, in a paper read before the Royal 
Medical and Chirurgical Society in May, 1896, 
73 



Meditations on Gout 

he expressed his opinion of its action, based upon 
a long experience, as follows : — 

" 1. Guaiacum is innocuous, and may be taken 
for an indefinite period of time, and looked upon 
as a condiment rather than as a drug, — as harm- 
less as ginger or any other condiment. 

"2. Guaiacum possesses a considerable power, 
but less than colchicum,in directly relieving patients 
suffering from gouty inflammation of any part ; 
it may be given whenever there is but little fever. 

"3. Guaiacum taken in the intervals of gouty 
attacks has a considerable power of averting 
their recurrence; in fact, it is a very powerful 
prophylactic. 

" 4. Guaiacum does not appear to lose its pro- 
phylactic power by long-continued use. 

"5. There are a few persons who cannot read- 
ily continue the use of guaiacum ; for such cases 
there are other drugs whose action is in some re- 
spects similar as prophylactics ; perhaps serpen- 
tary is one of the most powerful of these." 

Many of the seventeenth-century herbalists and 
doctors who have quaffed deeply from the founts 
74 



The Palliatives 

of Dioscorides and Pliny, are replete with cathol- 
icons derived from the vegetable kingdom, such 
as all-heal, wood-betony, burdock, gout-wort, hen- 
bane, tansy, garden-rue, kidney-wort, May-lily, 
great daisy, cowslip, and others too numerous to 
mention. Old Gerarde in particular, whom Dib- 
din loved to peruse, is always picturesque, whether 
speaking of plants or ailments; his allusions to 
Gout being of especial vigour and fire. 1 

1 It (the great-daisie) likewise asswageth the cruel tor- 
ment of the gout, used with a few mallows and butter 
boiled and made to the forme of a pultis. ( The Herball or 
General I History of PI antes. ) 

The Cowslips are recommended against the paine of the 
joynts called the Gout, and slackness of the sinews which is 
the palsie. (Ibid.) 

The juice of Onions mixed with the decoction of Penni- 
real, and annointed upon the goutie member with a feather, 
easeth the same very much. (Ibid.) 

Corolline or Sea Moss. Dioscorides commendeth it to be 
good for the gout which hath need to be cooled. (Ibid.) 

Figs stamped with the powder of Fenugreeke, and vin- 
egar, and applied plaisterwise, doe ease the intolerable paine 
of the hot-gout, especially the gout of the feet. (Ibid.) 

Goutweed or Herb-Gerrard. The very bearing of it 
about one easeth paines of the gout, and defends him that 

75 



Meditations on Gout 

Rabelais has Gargantua prescribe a leveret's 
thigh as excellent for the Gout, — a belief which 
Pliny also refers to in his Natural History. At 
a later period Huet, referring to the passage of 
Rabelais, states that even during his day the 
majority of those afflicted carried the foot of a 
hare with them as a preventive, — a belief no 
stranger, perhaps, than the common practice at 
present of carrying a horse-chestnut in one's 

bears it from the disease. — Culpepper, The British Herball 
and Family Physician. 

Burdock. Tis good for swellings of the spleen, and of 
all other parts in gouty diseases. — JOHN Pechey, The Com- 
pleat Herbal of Physical Plants. 

For the Gout, take Aristolochia rotunda, Althea, Betony, 
and the roots of wild Nep, and the roots of the wild Dock 
cut in pieces after the upper rind is taken away, of each 
alike quantity, boyl them all in running water till they be 
soft and thick : then stamp them in a mortar, as small as 
may be ; and put thereto a little quantity of chimney soot, 
and a pint of new milk of a Cow, which is all of one intire 
colour, and as much of the urine of a man that is fasting, 
and having stirred them all well together, boil them once 
again on the fire, then as hot as the party can suffer it, 
apply it to the grieved place, and it will give him ease. 
GERVAISE MARKHAM, The English House-Wife. 
7 6 



The Palliatives 

pocket as an antidote for rheumatism, or the 
faith in the horse-shoe and four-leaved clover. 

An old specific, which had descended with 
some slight variations in its composition from the 
times of Caelius Aurelianus, was termed Port- 
land Powder, from its having been purchased by 
the Duke of Portland who distributed the recipe 
for general use, on account of the service it 
appeared to have rendered him. Its ingredients, 
slightly modified from the recipe of the old Greek 
writers, consist of equal parts of the five follow- 
ing materials, finely powdered and mixed : — 
birthwort, gentian, germander, ground-pine, and 
the tops and leaves of the lesser centaury. The 
dose was a drachm taken fasting every morning 
for three months ; after which it is to be reduced 
to three quarters of a drachm for three months 
longer ; then to half a drachm for the remainder 
of the year ; after this the same dose is to be 
continued every other morning only, through the 
next twelve months, when a cure, it is presumed, 
will have been accomplished. This was consid- 
ered by Cullen an extremely dangerous remedy, 
77 



Meditations on Gout 

which, while often lessening the attacks, induced 
maladies like apoplexy, asthma, or dropsy, that 
frequently proved fatal. It has also been con- 
demned by various writers. 

Another preventive, so far as preventives go, 
was commended by Dr. Graves, of Dublin, as pos- 
sessing great virtues, although like the Portland 
Powder it has fallen into disuse. Its ingredients 
are as follows : Two ounces of orange-peel ; an 
ounce of powdered rhubarb, and two ounces of 
the pulvis aloes cum canella of the Dublin 
Pharmacopoeia, steeped for a week in a quart of 
brandy. A table -spoonful of the strained infu- 
sion is to be taken, mixed with two or three 
spoonfuls of water, night and morning. Sir 
Henry Halford has recommended what Dr. Wat- 
son considers a better form of prophylactic, viz. : a 
few grains of rhubarb, with double the quantity 
of magnesia every day ; or some light bitter in- 
fusion, with tincture of rhubarb, and about fifteen 
grains of bicarbonate of potash. Cullen recom- 
mended for strengthening the stomach, the 
use of iron; for supporting its tone, aromatics 
78 



The Palliatives 

cautiously employed; and when the stomach is 
liable to indigestion, the use of proper laxatives. 

Following the rest of the olden school, Sir 
William Temple, a martyr by inheritance, pre- 
sents some strange lenitives for the disease in his 
quaint and scholarly essay on the subject, to 
which the sufferer may be referred with enter- 
tainment if not with benefit, — the author having 
died of the affliction, despite his faith at the time 
in moxa and abstinence. Apart from these 
specifics, he refers to several cures through the 
use of guaiacum. One would scarcely care to 
try the heroic India remedy of burning moxa, a 
species of moss, over the affected part — even 
in " long and inveterate gouts ; " or the singular 
sedative of old Prince Maurice of Nassau men- 
tioned in the essay. Neither would one wish to 
experiment with the method practised by a 
Lorraine surgeon at the time — of " whipping the 
naked part with a great rod of nettles till it grew 
all over blistered." It was the author's firm con- 
viction, nevertheless, that for desperate cases 
heroic measures are required ; and that Gout was 
79 



Meditations on Gout 

" a companion to be treated like an enemy and 
by no means like a friend, which grew troublesome 
chiefly by good usage — that it haunted usually 
the easy and the rich, the nice and the lazy, who 
take care to carry it presently to bed and keep it 
safe and warm ; and indeed lay it up for two or 
three months, while they give out that it lays up 
them." 1 

Numerous other remedies or so-termed elixirs — 

" Bubbles that glitter as they rise and break — " 

have figured since Watson's day. Lartigue's, 
Blair's, Laville's, and various other specifics are 
well known ; one of the most recent is that of a 
chemist to the Duke of Cambridge, who is said 
to have amassed a large fortune in mending the 
nobility and patching up the followers of Port. 
Referring to such forms of medication, Cullen 
remarks : "I am much disposed to believe the 
impossibility of a cure of the gout by medicines ; 
and more certainly still incline to think that 
whatever may be the possible power of medicines, 

1 An Essay upon the Cure of the Gout by Moxa (1677). 
80 



The Palliatives 

yet no medicine for curing the gout has hitherto 
been found. Although almost every age has 
presented a new remedy, yet all hitherto offered 
have very soon been either neglected as useless, 
or condemned as pernicious." It has furthermore 
been demonstrated that, even among the accepted 
medicines, what is useful at one time may prove 
useless or positively injurious at another. Indeed, 
with regard to the efficacy of prophylactics, it 
may be said in the words of the Fcerie Queene : 

"No magicks arts hereof had any might, 
Nor bloody words of bold Enchanter's call." 

Unquestionably, it is difficult to improve upon 
the prescription of temperance in diet, and abun- 
dant open-air exercise or open-air labour, not 
only for Gout, but for nearly all forms of 
stomachic complaints. A sunny temperament 
also counts for much in exemption from gastric 
disturbances. One may laugh away indigestion 
to a great extent, as one may readily goad it on 
through worry and a sedentary life. 

Early rising has repeatedly been included among 
prophylactics, — a prescription that, seemingly of 
6 81 



Meditations on Gout 

little value in itself, may be of benefit in a reflex 
way in that it tends to early retiring; and thus, 
cutting short conviviality at night, may serve to 
curtail one's allowance of liquid stimulant. 

The value of certain medicinal springs, addi- 
tionally emphasised by their strict dietary and 
eliminative treatment, has long been recognized. 
At the same time their action does not always prove 
beneficial, and in some instances has resulted 
most disastrously. It is of the greatest moment, 
therefore, that the patient be intelligently advised 
as to the special Spa which will best suit his 
particular case, constitution, and temperament. 
Thus to some the Kreutzerbrunnen of Marienbad 
is recommended; to others the anti- arthritic 
waters of Kissingen, Wiesbaden, Homburg, or 
Vichy, according to the particular patient to be 
prescribed for. And yet so able an authority as 
Dr. Felix von Niemeyer, professor of pathology 
at Tubingen, states that he is unable to decide 
" which of the above springs deserves the preference 
in the treatment of gout, whether the solution of 
salt of which the Kissingen and Homburg waters 
82 



The Palliatives 

consist, removes the plethora more rapidly and 
completely than Carlsbad and Marienbad water, 
or the reverse. . . . Nor can we, with our present 
knowledge, say whether in any particular case 
the preference should be given to Kissingen, 
Carlsbad, Wiesbaden, Homburg, or Vichy, and 
what would constitute the peculiarity of the case 
which indicates one rather than the others." 1 

This statement, made in 1871, nevertheless does 
not coincide with the usual experience of experts, 
who distinctly specify certain Spas for certain 
conditions and phases of the disorder; Garrod, 
who has long been recognized as one of the most 
eminent specialists on the subject, summing up 
the matter as follows: "The particular water 
should be selected according to the nature of the 
case. When the patient is robust and of full 
habit, the alkaline springs ; when torpidity of the 
bowels predominates, the purgative waters ; when 
there is a want of vascular action, the saline 
waters; when the skin is inactive, the sulphur 
waters ; lastly, when debility prevails, then the 

1 Text-Book of Practical Medicine, vol. ii. 
*3 



Meditations on Gout 

more simple thermal waters should be chosen." 
The same writer, referring to hot-air and vapour 
baths and other means of increasing the cuta- 
neous secretions, does not hold to the more 
or less accepted opinion that excessive perspira- 
tion is a means of ridding the system of its 
morbid matters. 

One hesitates to question so distinguished a 
therapeutist as Garrod. Still, so protean is Gout 
in its nature and its effects upon different con- 
stitutions and temperaments, that it may be 
queried whether certain persons may not be 
much benefited by the judicious use of the 
Turkish bath, as well as by cool baths, and rous- 
ing the skin to activity by a vigorous use of the 
crash-towel. To some, much walking exercise at 
a time when most needed may prove an irritant 
to the susceptible joint ; while horseback exercise 
is not within the reach of all, or for various rea- 
sons may not always be advisable. Moreover, 
with some whose excreting powers through the 
skin are lethargic, and even with many in whom 
this function is normal, the quick cold or cool 



The Palliatives 

bath, taken when the body is warm, exercises a 
most tonical and invigorating influence upon the 
general system. 

These are considerations, like numerous others 
with reference to foods, stimulants, and various 
forms of exercise, that may not be regulated by 
any universal rule; but rather by the age, and 
peculiar conditions governing each individual. 
To supplement Garrod's and Niemeyer's state- 
ments concerning mineral springs, not a few 
physicians rigidly proscribe the waters of Carls- 
bad, Vichy, Vals, and some others, as dangerous. 
Trousseau, the French authority, believes in the 
beneficial action of medicinal springs ; but in a 
degree which is very limited. Not a year passes, 
he declares, in which he does not see the evil 
consequences of the use of mineral waters in 
Gout. 

Diet and exercise, however, are the most 
favoured catholicons, despite the fact that in 
attempting to trace the operative effects of cer- 
tain foods and drinks in creating and fostering 
the malady, there exist many subtleties which 
85 



Meditations on Gout 

have baffled the physician. The hypothesis has 
been advanced, that dietary articles containing a 
considerable amount of saline principles, such as 
salts of potash, tend to promote the activity of 
the secreting organs, more particularly the func- 
tion of the kidneys ; while many such substances, 
even if acid to the stomach, yet tend to alkalise 
the blood and animal fluid from the decompo- 
sition of the vegetable acid and a formation of 
the carbonate of the alkali. It is thus that lemon 
juice is said to be beneficial in rheumatism, 
consisting as it does largely of pure citric acid 
with a little lime and potash, — the presence 
of these latter as alkalies being supposed to 
act favourably in neutralising the rheumatic 
poison. 



86 



THE REGIMEN 



THE REGIMEN 

Resist him until resistance becomes habit, and he will 
not trouble you ; permit him liberties, and you are his. 

A Club of One. 

IVEN of more importance than 
what is eaten, is what is 
drunk ; and observation shows 
that it is not distilled spirits, 
but the stronger wines and 
Imalt-liquors which favour the 
production of the disorder. 1 " We should write 
few prescriptions," observes Niemeyer, " but 
should regulate the habits of the patient." " Live 
on sixpence a day, and earn it," was Sir John 
Abernethy's well-known reply to the question, 
" What is the cure for the Gout ? " — a remedy 
that would apply, no doubt, to many other afflic- 
tions as well. But like ^Esop's fable of the cat 
and the mice, the remedy is even worse than the 




1 Dr. F. W. Pavy, A Treatise on Food and Dietetics. 



Meditations on Gout 

emergency ; and who is there possessed of suffi- 
cient resolution to attach the bell ? 

If the stomach could only speak from its 
innermost caverns, voicing what it craved and 
what it resented, there would be far easier sailing. 
But it is almost impossible to constantly stroke 
it the right way. The innocent-looking orange 
that forms the stepping-stone to your breakfast, 
the grape-fruit that has been pronounced an 
antidote to rheumatism, or the strawberries that 
are deemed so healthful, may each and all be 
breeders of discord and fermentation in disguise. 
In the natural course of satisfying its needs, so 
many forms of aliments are partaken of that it 
becomes all the more difficult to decide which are 
the chief offenders. To go through a course of 
experiment with a certain order of flesh, starch, 
and vegetable foods with a view of tracing out 
the culprits, were a tedious and difficult proceed- 
ing. The problem then would be to detect the 
chief offender, where each one would lay the 
blame upon the others, and unite in the chorus, 
" Stop thief ! " 

90 



The Regimen 

And inasmuch as fats, starch, and albuminoids 
have each their separate processes of digestion, 
and severally and conjointly claim attention as 
regards their influence in the modifications of 
nutrition, as also in any remedial measures that 
may be adopted towards comparatively perma- 
nent relief — the complexity of the situation 
becomes trebly apparent. 

How is one to know, withal, whether the sweets 
or the sours are at the bottom of the trouble, or if 
both are equally prolific of mischief ? Experiment- 
ing with sweets might at once arouse the enemy ; 
while trifling with salads and acid articles might 
cause him to whet his tushes for a fresh attack. 

As regards wines, the quandary is still worse, 
when one considers the various effects of the 
same wines upon various persons, and even upon 
the same persons at various times. Or, as Master 
Burton has anatomically phrased it, " So one 
thing may be good and bad to several parties, 
upon divers occasions; and that which is con- 
ducing to one man, in one case, the same time 
is opposite in another." 
91 



Meditations on Gout 

On the other hand, any endeavours to regulate 
oneself by the physicians, when stomachs are 
so radically different in their special likes and 
dislikes, is equally out of the question. The 
further difficulty of pleasing one 's stomach also 
occurs in the natural course of events, inasmuch 
as certain foods are placed upon the table, and 
one must perforce choose from these. And of 
such, which are innocuous and which are noxious 
becomes a matter most difficult to determine; 
when even the use of oat-meal has been known 
to be a prolific source of trouble, and the free use 
of celery, both in cooked and uncooked form, 
has been deemed of much benefit in not a few 
instances. Oat-meal, it may be remarked, often 
proves very heating to many, and is a not infre- 
quent cause of stomachic derangements both in 
children and adults ; the large amount of gluten 
it contains rendering it difficult of digestion. 
Many of the tough, leathery gelatine compounds 
which are often placed on the table by an in- 
competent priestess of the range, are likewise, in 
many stomachs, rocks of stumbling to digestion. 
92 



The Regimen 

To what extent, furthermore, when acquired 
and not transmitted, depending as it does upon 
so many stomachic aberrations and vagaries, 
even unto slight gastric derangements on the 
start — to what extent may not Gout in numer- 
ous instances be largely a case of predisposition, 
just as one may have a susceptibility for catching 
cold, or a talent for business or money -getting ? 
Cullen, however, has already anticipated the 
reply to the question : "In a disease depending 
so much upon a predisposition, the assigning 
occasional causes must be uncertain ; as in the 
predisposed, the occasional causes may not 
always appear, and in persons not predisposed, 
they may appear without effect." 

What, then, by way of pacifying the stomach, 
shall the afflicted eat and drink, and wherewithal 
shall they be regulated ? To one possessed of a 
full appetite — and very many who are subject to 
gastric disorders are possessed of good appetites — 
it is as easy to render life a burden by constant 
restrictions as it is to render living onerous by 
flagrant excess and gross violation of self-evident 
93 



Meditations on Gout 

hygienic rules. The man who abjures all alco- 
holic fluids, as compared with him who partakes 
of them in moderation, may or may not add a 
year or two to his life ; but he foregoes a source 
of lightening care and lessening the asperities of 
daily existence. Of course for those who cannot 
preserve the golden mean and are incapable of 
using without abusing, the only remedy is total 
abstention from alcohol, and a strict set of rules 
to apply to all forms of nourishment. For not 
only wine, but many other things as well are — 

" — like rain, which when falling on mire makes it the 
fouler ; 
But when it strikes the good soil wakes it to beauty and 
bloom." 

But it is far from following that he who re- 
nounces all spirituous beverages, or gives himself 
up to stomachic monasticism, will thereby neces- 
sarily escape the bane of dyspepsia or rheumatism, 
even though he may run the gantlope of Gout 
in comparative safety. Nor for the cure of a 
purely acute malady — especially if induced by 
causes of an exasperating temporary nature, when 
94 



The Regimen 

severe dietary restrictions become imperative — is 
it always necessary or advisable to continue an 
ascetic treatment. But a peculiarity of Gout is 
that it seldom occurs without repeating itself in 
the acute stage, or merging into some of its pro- 
tean phases. 

The question of foods and fluids becomes 
accordingly of notable consequence in connection 
with Gout. What is one to resign, therefore, 
and what is one to retain amid the innumerable 
aliments contributed by the storehouse of the earth 
for the maintenance and delectation of mankind ? 

In the varied advice that is proffered by medi- 
cal writers respecting regimen in the disease, 
there are many opposing theories, founded 
as they are upon the various theories of the 
nature of the malady. "The whole point of 
the diet treatment of uric-acid disease," in the 
opinion of Haig, "is to cut out the butcher, and 
live by the baker, the dairyman, and the fruit- 
erer." x A milk diet has frequently been found 

1 Dr. Alexander Haig, Uric Acid as a Factor in the 
Causation of Disease. 

95 



Meditations on Gout 

advantageous so long as it is persisted in, but 
when discontinued it is considered to result 
unfavourably in rendering the patient still more 
susceptible to toxic alterations. Vegetarianism 
is commended by some, although this is disap- 
proved by such authorities as Gairdner, Scuda- 
more, Garrod, LecorchS, and numerous others. 
A mixed and varied diet, on the other hand, with 
a moderate supply of meat, and due restriction 
in the use of acids and acid-producing elements, 
as opposed to a strictly vegetarian or other 
regimen, is considered the best suited for general 
application. In other words, such substances, 
whether solids or fluids, as are most easily 
digested and are least liable to mal- assimilation, 
should be chosen. Proper cooking will have 
much to do with remedial measures ; a bad cook 
can ruin the best digestion, as good cookery can 
do much towards regulating the well-being of the 
internal functions. Upon this perplexing subject 
— the relation of foods and drinks to the dis- 
ease — we again find Professor Senator a sapient 
counsellor : — 

96 



The Regimen 

" Roughly speaking, the diet should be vege- 
table rather than animal, but absence from meat 
should not be pushed so far as strict vegetarian- 
ism. A mixed diet is accordingly the best — a 
diet containing a minimum of fatty matter, and 
in which the proportion of albuminoids, espe- 
cially of meat, is regulated in each individual 
case with due regard to constitutional strength, 
digestive power, occupation, etc. As a general 
rule gouty persons should only eat meat once a 
day, at their chief meal. Smoked and salt meat 
and fish, pork, cheese, farinaceous compounds 
containing much oily matter and highly spiced — 
indeed all culinary delicacies should be absolutely 
forbidden. Eggs and dishes containing them 
should be avoided as much as possible. On the 
other hand all kinds of soup, the more delicate 
varieties of meat, fish, shell-fish (oysters) in mod- 
eration, fresh vegetables and fruit may be recom- 
mended. Tea and coffee should be altogether 
abjured, or when the patient cannot bring him- 
self to do this, should be taken very weak. The 
patient's drink at meal times should be water, — 
7 97 



Meditations on Gout 

either plain water or one of the natural or arti- 
ficial carbonated waters containing alkalies or 
alkaline chlorides (soda-water, seltzer, Faching, 
Bilin, Giesshuebler Sauerbrunnen, carbonate of 
lithia, etc. Alcoholic liquors should never be 
taken to quench thirst, but only as roborants 
when they are really needed ; the best form then 
is a good red wine, neat, or diluted with water, 
or else a light beer brewed with a small propor- 
tion of hops ; the fiery southern wines, and those 
which are acidulous, champagne, and heavy beer 
(porter, etc.) must be forbidden." 

It will be perceived from the foregoing advice 
that the sufferer, in order to free himself from 
repeated onslaughts on the part of the enemy, 
must govern his palate with an iron hand, and 
enter into a solemn compact with that function- 
ary to relinquish all serious flirting with the 
sirens of the kitchen and the houris of the wine- 
cellar. The stomach, above all things, must be 
propitiated, and its good graces obtained as nearly 
as may be. To be sure, the price is an expensive 
one, calling as it does for the renunciation of 



The Regimen 

accustomed gustatory delights which have become 
a second nature to the individual. The philo- 
sophically inclined may reason with justice that 
few things that are really worth having can be 
obtained without certain sacrifices, — usually of 
labour or pains of some kind, the expenditure of 
money, or both. In the case of Gout there is 
this advantage, — that one's wine-bills may be 
lowered, and even the cards of compliment of 
the market-man and grocer may come in for 
their share of curtailment. And the wise may 
also justly reason that habit is a tyrant whose 
thrall has nothing in common with true enjoy- 
ment and is inimical to true happiness. The 
vegetarian who has renounced the flesh-pots, 
becomes not only content with his lot, but enjoys 
it, or affects to enjoy it; while the teetotaler, 
freed from the trammels of choosing among a 
multiplicity of vintages, waxes fairly riotous in 
the praise of his chosen beverage. Yet appetite 
too often rules, and fasting is proverbially hard. 
The fact remains that there is more pleasure in 
fondling with the minor vices than in courting 
99 



Meditations on Gout 

the virtues, especially in peccadilloes of eating and 

drinking ; and the seductive call of the palate is 

always far easier to obey than the duty -call of 

the stomach. It is easy enough to abstain when 

severe affliction comes, and still easier to relapse 

into one's accustomed ways when the crisis has 

passed, — 

" The devil was sick, the devil a monk would be ; 
The devil was well, the devil a monk was he." 

Regiminal precautions of a similar nature to 
those of Professor Senator are generally advised 
by the profession, with variations governed by 
the special case under consideration. For those 
variable elements, individuality and temperament, 
differing so widely as they do in man, must 
always enter into consideration in remedial 
measures. The physician should study his 
patient's constitution, as the agriculturist requires 
to familiarise himself with the soils he cultivates 
where certain elements may be lacking or certain 
noxious weeds are prone to appear. 

The prominent causative factor in Gout being 
acidity, which induces a corresponding decrease 



The Regimen 

of the normal alkalinity of the blood, it would 
seem to be of paramount importance that the 
patient avoid such foods and drinks as are known 
to provoke acidity, whether such foods and 
drinks be primarily of a highly acidulous nature, 
or whether they are merely acid-provoking 
agents. Yet it is well known that acids and acid- 
producing aliments may be taken by some 
patients with much more impunity than others, 
dependent not only upon the individual, but also 
upon climate, season, and mode of life which 
may operate as mitigating or influencing factors. 
So that sub-acid fruits, salads, and even wine in 
moderation may prove much less harmful in 
many cases than others ; though it should not be 
forgotten that wine and beer require to be par- 
taken of with extreme discretion. In all such 
instances the subject who has attentively studied 
his own constitution and digestion, should be 
fully as competent to judge as the physician. In 
this connection — the affinity that diet holds to 
acidity and acidity to Gout — the observations of 
Ewart, who has made a close study of the theme 



Meditations on Gout 

in his treatise of nearly six hundred pages, are of 
particular interest, more especially as illustrative 
of the idiosyncrasies of the disease : 

" Looking back into the clinical history of the 
subjects who acquire gout through high living, 
we often fail to trace any previous tendency to 
acidity. They are usually endowed with an ori- 
ginally strong digestion which only gives way at 
the approach of the gouty stage. Moreover, ex- 
treme acidity is presented by many subjects who 
do not develop the slightest tendency to gout. 
The mode of origin of acquired gout in itself sug- 
gests the operation of some nutritional disorder, 
whilst the result of this nutritional defect is obvi- 
ous in the eventual relative atrophy of the tissue 
elements. 

"It is conceivable that, as suggested by Beneke, 
the undue acidity may be itself the by-product of 
the faulty metamorphosis of cells. This would 
explain its persistence in inherited goutiness, even 
when metabolism is no longer oppressed and de- 
pressed by a reckless excess of ingesta. Accord- 
ing to this view, a depressed and faulty metabolism 



The Regimen 

would be the first departure, and abnormal secre- 
tion would be its outcome. . . . Meanwhile clin- 
ical analysis has made it clear that both in gout 
and in goutiness there are numerous varieties, 
and that, indeed, no two cases are absolutely alike. 
Two practical principles are its direct outcome: 
' Each patient has an individual gout of his own, 
for which an individual treatment has to be de- 
vised ; ' and, above all, ' We should treat the 
patient rather than the disease.' " 

Are fruits instrumental as acid-promoters, and 
thereby in inducing Gout and gastric disorders ? 
On this question, widely different opinions pre- 
vail, some deeming all fruit injurious, others con- 
sidering only certain kinds disadvantageous, and 
still others regarding nearly all forms as a direct 
corrective. By Linnaeus the strawberry was held 
to be antagonistic to Gout, although generally 
found to be difficult of digestion. Garrod dis- 
approves of all stone fruits, and of apples and 
pears unless baked ; but recommends strawberries 
in small quantities, oranges, grapes, and other suc- 
culent species. Grapes and oranges, which easily 
103 



Meditations on Gout 

yield their juice without any of the indigestible 
substance being swallowed, are pronounced by 
Ewing to be of all fruit the most suitable. 

Following in the lines of Crato of old, who re- 
garded nearly all fruits as injurious to the stom- 
ach, and Villanovanus, who held that they infected 
the blood and should be very sparingly used, 
Hoy, in his convenient treatise, " Eating and 
Drinking," has discussed this topic at greater 
length and precision than most modern writers 
on the subject. With many of his conclusions, 
one may or may not agree, although he declares 
that his experience is founded on careful experi- 
ments and observation dating from thirty years. 
This experience leads him to the belief that the 
majority of varieties and species of cultivated 
sub-acid fruits are distinctly pernicious to the 
majority of persons, both young and old — a 
prime cause of indigestion and very numerous 
disorders of the blood. Sweet fruits, like the fig } 
banana, and date, as also the pineapple, he com- 
mends, as they are merely wild fruits, and have 
not been changed from their natural conditions 
104 



The Regimen 

or flavour by man. On the other hand, the 
fruits condemned by him, he states, are forced or 
abnormal variations, as is shown when cultivated, 
and afterward allowed to run wild ; then they 
immediately retrograde, and assume the sour and 
inedible qualities originally inherent in them. By 
assiduous cultivation under artificial conditions, 
man has modified the progenitors of our present 
domestic fruits ; he has made them acceptable to 
the palate, but he has not eliminated their harm- 
ful qualities. 

Not only the strawberry, currant, and rasp- 
berry, but equally the apple, pear, cherry, peach, 
and grape are placed under ban, while hyper-acid 
species like the grape-fruit, shaddock, and orange 
are pronounced still more active agents of sto- 
machic fermentation, all tending to diminish the 
alkalinity of the blood. " The grape-fruit," sa/s 
the author, " having in its composition a large 
percentage of free acid and a somewhat bitter 
taste, is a favourite morning stimulant for those 
whose appetite needs forcing. It is known in 
Europe as the ' forbidden fruit,' and many would 
105 



Meditations on Gout 

be wise if they would so regard it." " Every 
cemetery in the land," he continues, " contains 
many little monuments on which the inscription 
should be, ' Killed by eating fruits under the erro- 
neous opinion that they formed a necessary part 
of infant diet.' " The acid fruits, he holds, are not 
adapted to furnish nutriment to man ; and tend 
to rob the blood of its alkaline principle — a con- 
sequent he applies in a lesser degree to the sub-acid 
species when partaken of in a raw state, as also 
to many of these when partaken of in the form 
of jellies and preserves. With certain meats, 
however, experience has shown that sub-acid 
fruits are wisely eaten, as apple-sauce with roast- 
goose and duck, cranberries with turkey, and fried 
apples v/ith roast pork. In view of the theory 
advanced and discoursed upon at length by the 
author, it may perhaps be possible to trace the as 
yet undiscovered baneful principle of wine as a 
promoter of Gout ; and to assign its poisonous 
element in the disease, not to the alcohol it con- 
tains, but to the essence of the fruit which lends 
to wine its exquisite savour and perfume. 
106 



The Regimen 

Concerning the nature of cultivated fruits in 
promoting acidity and fermentation, it may be 
observed that varieties vary largely in their diges- 
tive and non-digestive properties. Broadly speak- 
ing, crisp and firm fruits are not as readily 
digested as those of an opposite character. A 
Fameuse or a Jonathan apple is one thing; a 
Gravenstein or a Greening another, — the latter 
varieties being much more acidulous, and being 
more apt to disagree with some. So also with 
the Alpine and Hautbois strawberries, or our own 
wild strawberry, as compared to the unripened 
cone of the Sharpless, the intensely sour Wilson, 
and numerous highly acetous kinds. Of the qual- 
ities of the Spitzenberg apple, it is unnecessary to 
speak, while of the Northern Spy it may be said 
that although somewhat tart, it possesses an espe- 
cially refreshing and pleasant acid. The excess- 
ively sugary varieties of plums, like many of the 
Gages, and pears, such as the honied Seckel 
and Sheldon, are liable to provoke acidity from 
their over-sweetness. The silica or gritty par- 
ticles in certain varieties of pears, similar to some 
107 



Meditations on Gout 

of the many-seeded small fruits, like the rasp- 
berry and blackberry, often proves a source of 
indigestion. But who shall say that the ambrosia 
of a well-ripened Morris White peach and attar - 
of-rose savour of an Urbaniste or a Josephine 
pear should be left for the wasp and robin to 
extract upon the tree, and not be worthy to add 
their flavour to the dinner-table during the wintry 
season ! 

There is an appointed time to eat fruits, a 
period of maturity when the fruit is in entire 
possession of its virtues, which is little under- 
stood. The peach, plum, apricot, nectarine, and 
grape are best fresh from the tree and the vine. 
The apple and pear, notably the pear, should be 
plucked before they are fully ripe, and allowed to 
mellow, like wine. Some varieties mature early, 
some much more slowly. Many fruits are highly 
indigestible until kept for a considerable period. 
Others, that are digestible when ripe upon the 
bough, like the peach, are often picked when 
under-ripe for the market, and hence are received 
by the consumer in an improper condition. 
108 



The Regimen 

In many English estates where the peach and 
nectarine are grown under glass, it is customary 
to suspend a net beneath the trees, such fruit only 
being gathered as falls of its own accord. As an 
instance of the difference between well-matured 
and immature fruit, one has but to compare a 
Russet apple in its leathery stage when recently 
plucked, to a specimen of the same variety that 
has been allowed to fully mature ; or an Anjou 
pear tasted in October with one which has been 
stored and permitted to develop its vinous juices. 
But fancy a garden stripped of its fruit-trees, and 
a farm despoiled of its orchards! To accept 
Hoy's theory in its almost unconditional exclu- 
sion were to banish one of the noblest of 
the agricultural arts, and lay waste the teeming 
plantations of Pomona that so generously con- 
tribute to the resources of the husbandman and 
the nourishment of mankind. 

Placing the doctors and professional dietetists 
aside, the taste has its longings which it is some- 
times well to heed, general opinion to the con- 
trary notwithstanding. If its fancies are often 
109 



Meditations on Gout 

adverse to the true welfare of the stomach, and it 
prove itself frequently an unreliable Cerberus in 
guarding that important organ from its assailants, 
— its promptings, on the contrary, are not in- 
frequently a demand from the seat of internal 
weal or woe for the exact panacea that will best 
meet its especial requirements at such especial 
time. The palate therefore, prompted by the 
stomach, has its likes and dislikes, its hankerings 
and aversions which, even where these are ap- 
parently anomalous, it is often wise to heed ; for 
toujours perdrix in the matter of a set line of 
food and drink may even decide the Gout to 
show his fangs anew, and cry out for variety and 
relief. By this statement it will not be under- 
stood that it is advisable for those who may be 
suffering from chronic Gout to indulge in Port 
and red currants, or for a diabetes patient to 
assuage his thirst with Champagne. 

There are times, however, when sweets or acids, 
as the case may be, are intensely craved, much as 
animals crave salt ; and the question then arises by 
those who do not practise making a daily diary of 



The Regimen 

their stomachs, whether these should be entirely 
abjured. " Good is a good doctor, but Bad is 
sometimes a better," Emerson truly says. Many 
a man can ascribe his convalescence from a fit of 
sickness to a salad, a fruit, or a glass of wine 
which his physician would not have countenanced 
at the time, just as Count Bechamel dated his 
recovery and fifteen years of added life to three 
glasses of old Constance and a Perigord pate at a 
time when he had been given up to die. In the 
instance of fruit, like many other kinds of 
aliments, experience should be the best teacher, 
and the demands and aversions of one's particular 
constitution, as opposed to mere dogma, should 
be the safest guide. To be constantly theorising 
of what one may eat and what one should leave 
alone, or considering whether one should gra- 
hamise or vegetarianise — measuring this and 
weighing that — is enough in itself to develop 
gastralgia, and render existence a torture. 

Finally, as concerns the choice of foods in 
Gout, a case mentioned by Cheyne, one of the 
old masters, is worthy of citation. For, however 



Meditations on Gout 

the medical profession of the present day may 
cavil at his theory, the patient will doubtless find 
much to commend in the "triming" method he 
advances, and in his daily allowance of a pint of 
" some generous, soft, balsamick Wine." 

" A Gentleman of fine Parts, grieviously afflicted 
with the Gout, and with a perpetual Lowness, 
Sinking, and Oppression, both in Fits, and the 
Intervals, being weary of a life under such 
Miseries, was willing to attempt anything prob- 
able to mitigate them. But being justly afraid 
of a total Milk and Vegetable Diet . . . ; there- 
fore a triming and middling Diet being propos'd, 
chiefly of light, fresh River Fish (as least inflam- 
ing, and not over enriching the Juices) alternately 
with Milk and Vegetables; and every Day the 
Value of a Pint of some generous, soft, balsamick 
Wine (as Sack, Canary, or Palm), he readily 
and cheerfully enter 'd upon it. This Method 
abated both the Violence, Duration, and Fre- 
quency of his Fits in a few Years, without any 
Danger at all ; especially by almost every Night 
taking a few Spoonfuls of a Rhubarb and Bark 



The Regimen 

Bitter, made on Wine with Aromaticks, in the 
Intervals ; and he has now only a very tolerable, 
short, regular Fit once a Year, and soon gets 
about his Business again, and is in likelihood 
to go on with Health and Strength to a great 
Age. 

" I cannot omit here to observe, that if any 
person designs, either for the sake of Health, 
Long Life, or Freedom from Diseases, to regulate 
his Diet, I universally prefer to all others this 
triming Method of an alternate Diet of Milk and 
Vegetables one Day, and the other plain or young 
Animal Food, and a moderate portion of Wine ; 
for if his Case requires his descending still lower, 
yet this triming Diet will be the best and safest 
first step to begin with; and if his Recovery 
thereafter be so perfect, that he may rise to a 
higher Diet, this will make the Transition safer ; 
and even those who love palatable and delicious 
Foods, to a great degree, will bear a Maigre Day 
more easily when they know they shall have a 
Gaudy one the next; and I have known those, 
who from a weak Nervous and Cachectick Habit 
8 113 



Meditations on Gout 

have arriv'd to a confirm'd State of Health, noble 
Spirits, and great Age, by this Trick alone ; so 
that Fasting and Abstinence in this manner 
might seem not more a religious than it ought 
to be reckon'd a medical Institution." x 

After all has been said by doctors, dietarians, 
and philosophers the question of diet and the 
golden rules of hygiene have nowhere been more 
plainly set forth than by the son of Sirach of 
old: — 

" Take not thy pleasure in much good cheer. . . . 
Be not unsatiable in any dainty thing, nor too greedy 

upon meats. 
For excess of meats bringeth sickness, and surfeiting will 

turn into choler. 
By surfeiting have many perished; but he that taketh 

heed prolongeth his life. . . . 
Shew not thy valiantness in wine. . . . 
For all things are not profitable to all men, neither hath 

every soul pleasure in everything." 2 

i George Cheyne, M. D. The English Malady: Or A 
Treatise of Nervous Diseases of all hinds. (2d ed., 1 734.) 
2 Ecclesiasticus, 18, 37, 31, 37. 



114 



THE PROSCRIBED FLUIDS 



THE PROSCRIBED FLUIDS 



If your Physitian thinke it not good that you drinke wine, 
or eate such and such meates Care you not for that, I will 
finde you another that shall not be of his opinion. 

Montaigne. 
Nous sommes gens qui n'avons pas 
Toutes nos aises ici-bas. 

La Fontaine. 

GREATER discrimination, as 
has already been observed, ob- 
tains with reference to wines 
and alcoholic drinks than with 
respect to foods ; the consider- 
ation of this feature being of 
notable interest and presenting many anomalies. 
Alcohol is almost universally considered injurious 
in the diathesis, both by increasing the production 
of uric acid, and by lessening the excretory power 
of the kidneys through its continued use. Yet 
this subject is a relative one, depending in no little 
measure upon the quantity consumed and the 
form of fluid in which it is combined. The 




117 



Meditations on Gout 

medical opinion, nevertheless, regarding certain 
wines and liquors is almost unanimous. In the 
codex expurgatorius are included such wines as 
are rich in alcohol and saccharine matter, or of a 
heating, stimulating nature ; those which are gen- 
erally considered most baneful being Port, Madeira, 
Burgundy, Sherry, Malaga, Champagne, the heavy 
growths of the Cotes du Rhone and the honied pro- 
ducts of the Pyrenees Orientales. 1 To such must 
be added the luscious sweet Sauternes. These with 
their engaging colour, fragrance, savour, and 
sparkle, as they gleam or foam in the glass and 
distil their generous warmth, are to be shunned as 
one would the noisome effluvium of the Upas tree. 
Their rubies are tainted, and their ambers infect. 
Malt liquors are also usually proscribed, no- 
tably porter and heavy ales. As far back as 
Galen's day, fermented cider was thought to 
have little power in inducing the disease, whereas 
when taken in considerable quantities in its sweet 
and partially fermented state, it is recognised as a 

1 Nothing is more potent than port wine in leading to 
the production of gout. — Dr. F. W. Pavy. 
118 



The Proscribed Fluids 

predisposing cause. In those districts where it is 
largely consumed, Gout is little known ; and 
hence it has been regarded by many persons as a 
preventive ; the fact being lost sight of that it is 
thus largely employed by those who lead a simple 
and laborious life, and earn their daily bread by 
the sweat of their brow. Were the Normandy, 
Brittany, or the Devonshire peasant to inherit a 
generous fortune early in life, and, lapsing into lux- 
ury, continue his copious libations of apple-juice to 
wash down rich entrees whilst leading a sedentary 
and irregular existence, it is a question whether 
cider would not prove a dangerous draught. 

Distilled spirits are regarded as considerably 
less injurious than those forms of beverage 
already specified. The same applies to the lighter 
kinds of French and German wines, and the 
lighter beers as brewed in Germany, — German 
beer as made for export being considerably 
stronger than that brewed for home consump- 
tion, and losing in sprightliness and delicacy when 
subject to long voyages. Of distilled liquors, 
rum is considered the most objectionable except 
119 



Meditations on Gout 

arrack, absinthe, or any liquor distilled from rice ; 
or liquors like the sweet cordials in which the 
essential oils of various aromatic herbs, and ex- 
traneous sugar are employed. Garrod recom- 
mends French brandy as the beverage most 
suitable for those of a strongly marked diathesis, 
to be taken in very limited quantities, freely 
diluted with water. 

Why distilled spirits should be less pernicious 
than fermented beverages, has not been deter- 
mined ; the sages simply do not know. Again, 
how far alcoholic fluids are pernicious in them- 
selves, or how far a united action of alcohol and 
food is responsible for detrimental chemical changes 
in such food has not been defined. It is not the 
relatively small amount of alcohol that enters 
into the composition of many wines which works 
the mischief, it would appear, so much as its 
combination with their other ingredients ; or, as 
previously mentioned, its evil fusion with numer- 
ous aliments. Certain it is, from abundant testi- 
mony which cannot be disputed, that wine, more 
noticeably sweet and heavy wines, does exert a 



The Proscribed Fluids 

pronounced influence in developing the dyscrasia ; 
and that sugar, as also saccharine, is more diffi- 
cult to digest in connection with wine than in any 
other form. 

All wines that contain much tannin are con- 
sidered prejudicial ; while those which cause a 
marked diuretic action are pronounced less ca- 
pable of aggravating the malady. Notwithstand- 
ing this, the wines of Bordeaux, or so-termed 
" clarets," are generally recommended, where the 
use of wine is countenanced. And yet the Bor- 
deaux wines, especially those growths of good 
years, — so dear to the wine-lover, — are rich in 
tannin, a component that bends greatly to their 
quality and their preservation. 

" Neither the acid, sugar, nor any known prin- 
ciple contained in these liquors," says Garrod, 
"can as yet be proved to impart to the alcohol 
its predisposing influence ; for wines the least acid 
and liquors the least sweet, are found among the 
most baneful. Alcoholic fluids which have little 
tendency to cause dyspepsia, and those which 
more especially act as diuretics, can, as far as 



Meditations on Gout 

gout is concerned, be taken with greater impunity 
than beverages of an opposite character." " If 
you drink wine, you have the gout, and if you 
do not drink wine the gout will have you," is an 
old saying. "Water alone is bad and danger- 
ous," was a precept of Sydenham, who recom- 
mended the use of a mild ale brewed in London, 
and permitted the use of wine, — the wines of 
Spain and the Canaries in preference to those of 
France and Germany. With the changes in vin- 
ification since the seventeenth century, however, 
it is highly improbable that such would have been 
his advice at the present time. " Wine may 
prove injurious as an ordinary beverage," accord- 
ing to Trousseau, "but the exclusive use of 
water will be still more hurtful." 1 

Among the Spanish wines and growths of 
Andalusia, that of Manzanilla or Mancanilla, 
made near Xeres, is the driest and most aromatic, 
acting upon many constitutions as a stomachic 

1 It is hurtful to drink wine or water alone, and wine 
mingled with water is pleasant and delighteth the taste. 
(Apocrypha, 2 Maccabees xv. 39.) 

122 



The Proscribed Fluids 

and diuretic. Sherry in general is not open to 
the great objection of Port, inasmuch as but a 
very small quantity of foreign alcohol is added 
to it, — usually at the most a few bottles of 
brandy to each butt; in the brown sherries, an 
addition of boiled wine is made to impart the 
desired dark shade. Madeiras, on their part, vary 
largely in qualities, — some being over-sweet 
through the fermentation having been checked, 
and the addition of brandy to the must ; others 
being astringent; and all receiving an admix- 
ture of brandy in a greater or less degree on 
exportation. 

In the case of the sweet Sauternes, this ex- 
cessive sweetness is produced not only by the 
selection and crushing of such grapes as have 
ripened to a point of over-ripeness, but by ar- 
resting the fermentation of the must through 
sulphuring. This arrest of the fermentation also 
prevails in many of the finer Auslesen of the 
Rheingau and the Bavarian Palatinate, to the 
injury of the keeping qualities and the finer 
vinous properties of the wines. 
123 



Meditations on Gout 

Generally speaking, the lighter wines of France 
and Germany, as made to-day, are a refreshing, 
tonical, and pleasing beverage; and in many 
countries the daily use of such wines appears to 
be distinctly favourable to the general health. 
Recent statistics of the different departments of 
France, whose wines vary widely in character, 
show that the department of the Gironde, one 
of the greatest producing and consuming districts 
of that country, as well as the department of 
the Yonne, are especially noticeable for the lon- 
gevity of their inhabitants. In both of these 
departments red and white wines are generously 
consumed ; the red predominating in the Gironde, 
while in the Yonne, the home of Chablis, much 
more white wine is drunk than in the districts 
about Bordeaux. 

Some subtle and deleterious property, notwith- 
standing, — a property that proves deleterious at 
least to certain constitutions, and that is more 
peculiar to fruits than to other forms of vegetable 
growths like cereals, — it would seem, lurks in 
the fermented fruit of the vine, such property 
■ 124 



The Proscribed Fluids 

being much less marked in brandy, the distilled 
product of the Folk Blanche grape. Some 
constituent of the grape itself, similar to the 
toxic component of the strawberry and certain 
other fruits — more highly emphasised in red 
varieties of the grape than in white, unless the 
rich saccharine white wines be included, and yet 
more pronounced when the grapes are fermented 
on the skin — undoubtedly constitutes the bane- 
ful element. Does this toxic ingredient reside 
in some volatile oil or oenanthic ether of the skin 
of certain grapes ; is it evolved in the fusion of 
the particular fruit essences with the alcohol en- 
gendered by fermentation ; or is it the pernicious 
combination of wine with certain articles of food 
that is at fault and to which the formation of the 
poisonous elements in digestion, as far as wine is 
responsible, should be ascribed ? These are ques- 
tions that as yet await the answer of the analyst. 

In the instance of malt-liquors, the solution is 

more readily definable. It is recognised that any 

ingredients employed to take the place of hops 

and barley-malt, or to assist in quick develop- 

125 



Meditations on Gout 

ment, clarification, or a frothy head, however 
cunningly employed to deceive the taste, are 
injurious, and frequently responsible for dan- 
gerous kidney and liver affections. Even in 
distilled liquors it is well known that rice is a 
detrimental component, and that it becomes still 
more hurtful in fermented fluids. Long expe- 
rience has demonstrated that the light beers of Ger- 
many when drunk in that country, as compared with 
the malted products of other countries, are rela- 
tively harmless unless drunk in inordinate quan- 
tities; that the heavy English ales and porters 
are objectionable as a daily beverage ; and that 
the consumption of all adulterated forms of beer 
and ale is attended with peril. It may be said 
with reference to the comparative noxiousness or 
innocuousness of malt liquors that the following 
conditions play the principal part: the use of 
hops and barley-malt alone, the quality and 
quantity of the hops and malt employed, the 
purity of the water, the system of fermentation, 
the proper maturity of the fluid, and the presence 
or absence of aldehyde, gluten of the malt, and 
126 



The Proscribed Fluids 

fusel oil. All these are important mediums with 
relation to the injurious or non-injurious effects 
of beer and ale. 

With wine, as has been stated, the problem is 
far more difficult to determine. What, then, are 
the constituent parts of wine ; what elements has 
it extracted from the soil, the sun, the dew, the 
rain, the atmosphere, and the vat ; what does its 
fluid resolve itself into in the retort of the chem- 
ist ? Of what are they composed — these ethers, 
odours, and fugacious fragrances and flavours 
that have hived and ripened their delicious sweet- 
nesses in the bottle through the long autumns 
and winters, and swift -speeding springs and 
summers of the years ? 

The components of the product of the vine 
consist principally of water and alcohol, — the 
quantity of spirit which is evolved by the fermen- 
tation of the saccharine matter in the vat varying 
according to the seasons, the locality, the kinds 
of grapes employed, and the period and mode 
of gathering the fruit. Besides this water and 
alcohol, there are contained numerous soluble 
127 



Meditations on Gout 

ingredients, as oenanthic and other ethers, free 
acids, and salts, together with extractive or muci- 
laginous or colouring matters, and astringent and 
saccharine properties. The acids and salts are 
composed principally of the acid tartrate of 
potash, and different forms of tartaric acid, much 
of which is decomposed during fermentation, 
as also, in the generality of wines, malic, citric, 
and acetic acids. There exist, likewise, relatively 
small amounts of other salts, such as iron, mag- 
nesia, and phosphate of lime. It may be briefly 
said that the distinguishing characteristics of wines 
lie first of all in the species of fruit from which 
they are made, — the different qualities of the 
growths of a district varying according to the 
soil, location, and aspect of the territory on 
which the vine is grown. These distinctive 
bouquets, flavours, and alcoholic strengths be- 
come marked still further, even in adjoining 
vineyards, by the special combinations of grapes 
that form the must, and different methods 
of vitification and vinification. Moreover, the 
savour, as well as the proportions of the chemi- 
128 



The Proscribed Fluids 

cal constituents, of wine are largely dependent 
upon the mood of the season — whether Favonius 
smiles, or Vertumnus frowns ; whether the 
year prove hot or cold, moist or dry, tardive 
or precocious. 

It is claimed from statistics that Rhine and 
Mosel wines are the most harmless. Dr. Goeris, 
writing from Mayence, where the adult man 
drinks on an average three hundred and sixty 
bottles yearly, many drinking very much more, 
states that during twenty years only four cases 
of Gout came under his observation, and these 
were persons who led a sedentary life, and were 
addicted to the pleasures of the table, confining 
themselves by no means to the use of Rhenish 
wines. In Bingen, the very heart of the Rheingau, 
Gout, he says, is almost unknown. From these 
facts he concludes that Rhine wines contain no 
properties productive of the disorder, which is 
produced by admitting into the system an im- 
moderate quantity of azotic nourishment; to- 
gether with insufficient secretion and respiration, 
as also lack of exercise. On the contrary, Gout 
9 I2 9 



Meditations on Gout 

is of common occurrence in Munich and numerous 
places where beer is drunk in very large quan- 
tities; while adulterated beers, or beer in which 
glucose and other sophistications form a part, 
are undoubtedly as pernicious in their effects 
as Port. 

With respect to the influence of the wines of 
Bordeaux, a resident writes : " It is a mistake to 
suppose that these are a cause of gout. Our 
medical men prescribe them for those whose 
blood is poor, and who require strengthening. 
Certainly, if too much is taken, it will do harm, 
as too much food will ; but it is otherwise con- 
sidered beneficial for the health of every one to 
drink true Bordeaux wine." 

An English gentleman, replying to the inquiry 
which wine he found most likely to bring on 
Gout, states that in his instance the disease is 
hereditary, his father and two brothers having 
died from it. In his case he has observed that it 
is never developed except through indigestion, 
and hence his self -treatment has been to antici- 
pate indigestion, rather than to cure it. Though 
130 



The Proscribed Fluids 

he has found its occurrence depends upon a 
multitude of circumstances very different from 
the taking of wine, he also finds that certain 
wines are much more likely to produce it than 
others ; and these, therefore, he avoids. The 
two which he is obliged to be most cautious 
about are Port and Burgundy. All others he takes 
freely without any reason to believe them at all 
injurious ; even Burgundy and Port he can take, 
in moderation, with perfect impunity. " Ten or 
fifteen years ago," he continues, " before I under- 
stood how to manage myself so well as I have 
since learned by experience to do, I used to have 
gout three or four times a year. I then adopted 
my present precautionary system, including great 
moderation in Port, and taking principally white 
wines, and I found immediate benefit. For the 
last ten years my principal wine daily is fine 
Madeira, and frequently Champagne; and my 
attacks have been reduced from three in twelve 
months to four in twelve years ! You will 
observe that I condemn no wine in moderation ; 
but those I find least likely to cause indigestion, 
J3 1 



Meditations on Gout 

and consequently the best to avoid gout, are 
Champagne and Madeira; that is, assuming 
both to be fine wine, pure, and of the best 
quality ; but the grand prophylactic is, not 
merely to keep down indigestion, but to fore- 
stall and prevent its approach." 1 

" I call my gout," Lowell declares, on the other 
hand, "the unearned increment from my good 
grandfather's Madeira, and think how excellent it 
must have been, and sip it cool from the bin of 
fancy, and wish he had left me the cause instead 
of the effect." 

It will be noticed that in the instance previously 
cited, Madeira and Champagne, two wines that 
are invariably placed upon the black-list, were 
drunk with comparative impunity. This would 
point to one of two conclusions : either that 
Champagne and Madeira are healthful anti- 
arthritic beverages to some, — the former, when 
not sweet, or adulterated with alum as it frequently 
is in the "brut" form, acting perhaps as a 

i Thomas George Shaw, Wine, the Vine, and the 
Cellar. 

132 



The Proscribed Fluids 

tonic, and the latter as a diuretic, — or that so far 
as wines and foods go, there can be no certain 
regimen prescribed which will meet the infinite 
vagaries of the universal stomach. 

This interesting experience, however, comes 
nearer to a remedy than any contained in medi- 
cal treatises, without abstinence from alcoholic 
beverages and semi -starvation as the penalty. 
But as the experience stands, it is of little avail, 
through default of thorough data as to what the 
special "management" consisted of, and what 
sort of a ha-ha, moat, or stockade was applied to 
thus intercept mal-assimilation, the main excitive 
of the evil; for beyond the recipe of Madeira 
and Champagne, which might prove so much 
strychnine to some, it is not stated whether 
medical agencies were employed, or whether the 
palliative depended largely upon occasional fast- 
ing, heroic exercise, thermal treatment, or the 
avoidance of particular foods. Moreover, as this 
experience was chronicled over thirty years ago, 
it is more than likely that any efforts to trace 
the prophylactic would be futile. It may be re- 
i33 



Meditations on Gout 

marked, nevertheless, that Port and Burgundy 
are invariably dangerous companions, and gen- 
erally hold the right bower. For is it not pro- 
verbially Port 

" That keep'st the ports of slumber open wide, 
To many a watchful night " ? — 

while as regards the fermented juice of the black 
Pinaud grape, the old refrain should ever be 
borne in mind — 

" Burgundy rose ! Burgundy rose I 
'Tis a very bad thing at the tip of your toes ! " 

Burgundy is dangerous, and the wine of the 
Douro yet more so. Indeed, Petrarch never 
followed the footsteps of Laura, or Herrick the 
form of Anthea with greater devotion than Gout 
waits upon his favourite handmaiden, Port. 

What renders Port especially harmful, apart 
from the natural richness of the wine itself, is 
the adventitious alcohol it always contains, with 
frequently extraneous sugar and other foreign 
ingredients. Sugar is also very often added to 
many of the red Burgundies, to the impairment 
i34 



The Proscribed Fluids 

of the colour and life of the wine, and equally to 
the health of the consumer. The undue propor- 
tion of Gout that has long existed in England as 
compared with other countries, can be traced 
largely to the revolution of 1688 and this addi- 
tion of extraneous spirit ; previous to which, and 
up to the date of the Methuen Treaty, the " claret " 
of France had been the general beverage among 
the wine-drinkers of Great Britain. Since 1688 
the duty on French wines was raised from Is. 
Ad. to 45. \§d. per gallon, or three hundred and 
sixty per cent; and by the Methuen Treaty of 
1703, the gates were opened wide by gouty 
Queen Anne for Port and its boon companion, — 
the produce of Portugal being received at a rate 
of one third less than that of France. 

Since that date, down to I831, the differential 
rates against French wines were never less than 
fifty per cent; and before the Methuen Treaty, 
such Port as was consumed in Great Britain was 
not fortified by extraneous spirit. It was in 1715 
that the Portuguese first began to mingle a little 
brandy with the wines they sent to England, — an 
i35 



Meditations on Gout 

obnoxious custom that has largely increased up 
to the present time. This prohibitive tariff, a 
result of England's jealousy of France, became 
accordingly the means not only of forcing Port 
upon the English, but of subsequently obliging 
wine-consumers to drink the adulterations of an 
interested wine company to whom a monopoly 
of the Upper Douro was given in 1756. More 
than this, it was also the means of forcing all 
manner of sophisticated wines, adulterated to 
resemble Port, upon the consumers. 

This practice of adulteration eventually spread 
to France. Writing in 1775, Barry states that 
French " claret " was largely mixed with Spanish 
wine at that period, and likewise complained that 
Port had become more heady and heating than 
it formerly was, requiring more time to bring it 
to maturity after bottling than was previously 
necessary. 1 From 1787 to 1810, the largest 
amount of Port was drunk in Great Britain ; the 
greatest quantity ever exported from Portugal 

1 Sir Edward Barry, Observations on the Wines of the 
Ancients. 

136 






The Proscribed Fluids 

was in 1825, when 40,277 tuns, equivalent to 
forty thousand cases of Gout, were shipped to 
England. In Portugal itself, where Port is 
naturally drunk in considerable quantities, but is 
not fortified for home consumption, Gout is said 
to be of comparatively infrequent occurrence. 
The excuse made for thus vitiating the wine, is 
that it renders it better able to withstand the 
fatigue of the voyage ; whereas the true and 
only reason for the pernicious custom is that 
immature wine and wine of poor years may be 
palmed off for old and full-bodied vintages, 
as also that good vintages may be sold at 
immaturity. Besides this adventitious alcohol, 
where twenty to twenty-five gallons of native 
brandy much above proof is frequently added to 
the pipe, elderberries are often freely used to 
impart their dye, together with sugar and jeropiga, 
— a syrup made from must, prevented from fer- 
menting by means of spirit. 

Yet as far back as 1677 Sir William Temple 
called attention to the fact that he had noticed no 
disease of that age which had increased to such 
i37 



Meditations on Gout 

an extent as Gout. His observations on wines 
will additionally show what kinds were then in 
use among the higher classes and served, in 
conjunction with the heavy dishes of England, to 
augment the malady : " But the wines used by 
those that feel or fear this disease, should rather 
be Spanish or Portugal than either French or 
Rhenish ; and of the French, rather the Provence 
or Languedoc than the Bourdeaux or Cam- 
pagne; and of the Rhenish, the Rhinegaw and 
Bleker, of which at least it may be said that 
they do not so much harm as the others." x 

The growths of Provence and Languedoc, 
which he recommends in preference to those of 
Bordeaux and Champagne, it may be noted, have 
always been known as heady, heavy, and fiery, in 
comparison with those of the Gironde and the 
Marne ; and were certainly ill-advised on his part 
for use in Gout. Sparkling Champagne in 
Temple's time was unknown ; and it is to be 
presumed, therefore, that by the word " Cam- 
pagne," he has reference to the still red and white 

1 An Essay upon the Cure of the Gout by Moxa. 
138 



The Proscribed Fluids 

products, or at most to some of the naturally 
slightly effervescing products of that district, — 
unless by " Campagne " some other " country " 
of France was intended to be designated, which 
might have been Anjou, not a few of whose 
wines are also naturally slightly effervescent. It 
is extremely difficult to trace or to conjecture, 
however, what Rhenish wine he indicates under 
the title of "Bleker," — a term unknown to the 
present day, — unless he so specified some wine 
of the Mosel or the Saar, or possibly of Rhenish 
Bavaria. 

In any event, his advice was contrary to 
that of the generality of modern advisers, in- 
asmuch as he prescribes the rich Portuguese and 
full Southern wines, while he proscribes those of 
Bordeaux and only admits those of the Rhine 
under protest. He laid stress, likewise, on the 
daily use of wine as injurious in general, argu- 
ing, however fallaciously, that it having been 
-denied Great Britain by nature, it was never 
intended for common use in that country ; and 
he would accordingly relegate its employment 
139 



Meditations on Gout 

" for the times and occasions of feast and joy, 
and treating it like a mistress rather than a wife." 
Heavy ales and porter are of course to be 
charged with their share in extending the malady ; 
but not to the extent of Port and its adulterations. 
Suave, mellow, full-bodied, of a lovely colour, 
fragrance, and flavour, — its poison masked by 
unctuousness and age, — it is no wonder that 
this wine should have become so common a 
beverage in the damp climate and fogs of Eng- 
land, particularly at a time when the growths of 
the Gironde had not so generally attained the 
great excellence that characterises them to-day. 
And even now, though aware of the canker that 
lurks in the wine, an occasional after-dinner glass 
is hard to relinquish by those who may have felt 
its evil effects, but cling to the alluring taste of 
the Oporto grape. Rev. John Home, a Scottish 
divine and relative of David Hume, the historian 
and metaphysician, has told the story of Port 
in four lines, — the stricture having been written 
when a prohibitive duty on French wine was 
enforced in Scotland : — 
140 



The Proscribed Fluids 

" Firm and erect the Caledonian stood, 
Old was his mutton, and his claret good. 
' Let him drink Port ! ' an English statesman cried; 
He drank the poison, and his spirit died." * 

It may be added that before his death in 1 776, 
Hume attached a singular codicil to his will, 
relating to Port and to the author of the above 
epigram ; Hume being fond of the wine of Port- 
ugal, and Home preferring the wine of France : 
" I leave to my friend, John Home of Kilduff, ten 
dozen of old claret at his choice, and a single bottle 
of that other liquor called Port. I also leave to 
him six dozen of Port, provided that he attests 
under his hand, signed John Home, that he has 
himself alone finished that bottle at two sittings. 
By this concession he will at once terminate the 
only two differences that ever arose between us 
concerning temporal matters." This was assuredly 
a light burden when it is considered that finishing 
three and four bottles at a sitting was of frequent 
occurrence; but historical records fail to state 
whether Home secured or relinquished the three 
score and twelve bottles of his relative's cellar. 

1 Douglas, A Tragedy. 
141 



Meditations on Gout 

Home's invective differs from the later experi- 
ence of Lord Tennyson, — like Milton a victim of 
Gout, — who, in his poetic fantasia to the head- 
waiter of the " Cock," hymns the panegyric of 
Port ; the particular wine he sang of more than 
half a century ago having presumably escaped 
the taint of the elderberry and toxine of jeropiga, 
even though the brandy of Oporto mingled with 
its ruby tide : — 

" Head-waiter, honour'd by the guest 
Half-mused, or reeling-ripe, 
The pint you brought me was the best 
That ever came from pipe. 



" Head-waiter of the chop-house here, 
To which I most resort, 
I too must part ; I hold thee dear 
For this good pint of Port." 

It may be said the bard distinctly specified to the 
chief cup-bearer that the wine was to be perfect 
of its kind : — 

" But let it not be such as that 
You set before chance-comers, 
But such whose father-grape grew fat 
On Lusitanian summers." 
142 



The Proscribed Fluids 

The effect was magical, as the poet exultingly 
testifies, — an effect that could not have been pro- 
duced had the wine been otherwise than ripe and 
of a distinguished vintage : — 

" This earth is rich in man and maid : 

With fair horizons bound ! 
This whole wide earth of light and shade 

Comes out a perfect round. 
High over roaring Temple-Bar, 

And set in Heaven's third story, 
I look at all things as they are, 

But thro' a kind of glory." 

Amid the smoke and clangour of the precinct of 
St. Paul's, the thick crust and bees-wing sing 
from the poet's glass : — 

" The Muse, the jolly Muse, it is ! 

She answer'd to my call, 
She changes with that mood or this, 

Is all-in-all to all : 
She lit the spark within my throat, 

To make my blood run quicker, 
Used all her fiery will, and smote 

Her life into the liquor." i 

1 Will Waterproofs Lyrical Monologue. 
143 



Meditations on Gout 

Sauterne has been recommended by some 
writers as among the least injurious wines. In 
the able and interesting monograph by Dr. Fred- 
erick T. Roberts, the writer says : " Some patients 
are undoubtedly better if they take no stimulants 
whatever ; others can take proper kinds in mod- 
eration with advantage. It may be laid down as 
a general rule that malt liquors and all stronger 
wines are injurious. Those wines which are most 
acceptable are good clarets, Hock, Mosel, Chablis, 
and Sauterne. Even these must only be indulged 
in in strict moderation. A small quantity of 
good dry sherry suits some patients very well. 
A little brandy well diluted often agrees better 
than any other kind of alcoholic liquor ; or in 
some cases whisky or gin may be substituted. 
Whatever stimulant is selected should only be 
taken at meal -times, and the habit of drinking 
between meals is strongly to be deprecated. It is 
highly important that any alcoholic drink em- 
ployed should be sound and of good quality." x 

1 A Dictionary of Medicine ; edited by Richard Quain, 
M.D. 

144 



The Proscribed Fluids 

It is right here — in connection with wine — 
that medical counsellors, with scarcely an excep- 
tion, are misleading in their advice, which is 
invariably too general and not sufficiently spe- 
cific. None of them emulate Pliny, when, refer- 
ring to this all-important subject, he said, "I 
shall discourse of wine with gravity, approaching 
my topic, not as a physician, but as a judge 
who is to pronounce on the physical and moral 
health of the human race." 

Instead of regarding the subject from the 
standpoint of the oenophilist as well as that of 
the therapeutist, they merely generalise, refer- 
ring to the products of certain regions as more or 
less baneful or more or less salutary. Yet how 
different the various growths of a region, and 
even the different districts and individual growths 
of such districts ! Take the case of Sauterne, for 
example, under which general term must be 
included not only the wines of Sauterne them- 
selves, but those of Barsac, Bommes, Preignac, 
and Fargues, and often also the white wines of 
the Graves and Entre Deux Mers, — differing 

10 145 



Meditations on Gout 

most widely in strength, dryness, bouquet, and 
flavour. 

Furthermore, in speaking of Sauterne, it must 
be remembered that in all the finer wines such as 
Ch*? d'Yquem, Lafaurie, La Tour Blanche, Cou- 
tet, etc., there are at least four forms of the wine 
made from different gatherings, — the "head," 
"centre," "tail," and "ensemble," the latter a 
mixture of all three ; with sometimes a still 
more limited, luscious first-gathering, termed the 
"cream." These differ very materially in the 
quantity of their spirituous and other constituents ; 
notably in the amount of the saccharine element. 
This in turn varies immensely according to the 
particular year ; the finer wines also being always 
sweeter than the ordinary growths. 

To instance this great variation, one has but to 
recall the CtaF d'Yquem crime of 1864, — a gor- 
geous, oily, madeira-coloured wine of surpassing 
softness, flavour, and sweetness, and the tete of 
the same wonderful growth of 1888, with its 
relatively fresh, sub-acidulous flavour. Or the 
deliciously unctuous, Hymettus products of Ch?. u 
146 



The Proscribed Fluids 

Lafaurie of 1874 and 1884, and the compara- 
tively dry full-flavoured centre and tail wines 
of 1891. It may be added that the year 1864 is 
written in gold in the Sauternes district, while 
that of 1888 was considered an unusually poor 
vintage with white Bordeaux wines. 

But let it not be inferred for a single instant 
that the '88 products, or those of nearly any 
year from the peerless vineyard of the Marquis 
de Lur-Saluces, when bottled at the Chateau, are 
anything less than altogether lovely ! The tete 
wine of 1888 is exquisite, as is also the ensemble 
of 1891, and preferable, according to the writer's 
taste, to the more luscious pressing of 1890. 
The '61 's, '64's, and '69's, alas ! are past, except 
as fragrant memories, — unless one may savour 
them from the Marquis' cave particuliere. Some 
years are naturally more delicious and hold their 
age better than others — and some are more 
healthful. But one is not supposed to drink the 
essence of Yquem and Lafaurie — the nectar of 
the Semillon and Sauvignon — by the magnum, or 
otherwise than, on special occasions in appreciative 
147 



Meditations on Gout 

company, to sip a glass or two of their liquid gold 
at the close of the repast, with a benison to the pro- 
ducers, and to summon the smiling valley of the 
Ciron as it lies basking under the September sun. 

In recommending Sauterne, therefore, it will be 
readily apparent that the tail wines or drier wines 
should alone be prescribed, or the centre wines 
of ordinary years, or a light white variety of the 
Graves, or Entre Deux Mers. A case has come 
under the writer's observation where Gout was 
manifestly developed from the daily use of a 
sweet Sauterne. The thin semi-acidulous wine of 
Vouvray is preferable to many of the Sauternes, 
as are also numerous white wines of Tresses, 
Baurech, and Sainte Croix du Mont of the Bor- 
delais. These latter are said to be an alterative 
in diabetes, and of service in lessening gastralgia ; 
they are frequently used as an aperient in Gas- 
cony, being drunk by the disciples of Nimrod on 
starting for the chase, —pour tuer le ver, accord- 
ing to the local expression. 

Among the red wines of Bordeaux, prescribed 
by most physicians under the name of " clarets," 



The Proscribed Fluids 

the differences in character are almost equally 
marked ; as, for instance, between a good ordi- 
nary St. Julien or St. Estephe, and superior 
growths of the same communes, like Cfe? Leo- 
ville, Larose, and Duluc, or Cta? Montrose, Cos 
d'Estournel, and Calon-Segur. Then there are 
the exquisite, deep-coloured growths of Pessac, 
Merignac, Leognan, and Talence of the district of 
the Graves, led off by Ch*? Haut-Brion, and 
Ch a .v Haut-Bailly, among the most delicious red 
wines in the world, — rich, marrowy, perfumed, 
possessing a delightful flavour of fruits that re- 
calls a combination of Bordeaux and Burgundy, 
and particularly distinguished for the quantity of 
iron they contain. There are likewise the warm, 
generous, full-bodied products of St. Emilion and 
Pomerol, the former termed the red Burgundy of 
the Bordelais, with Ch*? Cheval Blanc as one of 
its best and most powerful growths. 

Furthermore, not a few of the finest of the 

classified cms of the Medoc and the Graves of 

the grandes annees, on attaining a ripe age, say 

from fifteen to twenty years, remind one some- 

149 



Meditations on Gout 

what in bouquet, fulness, and flavour, of fine 
old Port, the spirituous and saccharine elements 
of course being absent. This is more noticeably 
the case in the growths of Margaux, some of the 
St. Juliens and Pauillacs, and in the Pessac first 
growth, Ch^ Haut-Brion. 

Hock or Rhine wines are also favoured where 
the professional adviser sanctions the use of wine. 
Still, how different in qualities, ethers, and 
strength are the countless growths of the Rhein- 
gau, the Mosel, and the Saar, — the light 
Graacher of the Mosel with its vinous fragrance, 
and the strong Maximiner Grunhauser Heeren- 
berger of the same district, that distils an aroma 
of the elder -flower. And in the upper Rhenish 
growths and luscious Auslesens of the Lower 
River, how dissimilar the products of the Riess- 
ling and the Traminer! — the comparatively 
mild Niersteiner and powerful Rudesheimer 
and Rauenthaler ; and the heavy Deidesheimer 
Gewiirz Traminer, with its pungent odour of 
pears, and grand golden Forster Jesuitengarten und 
Kirchenstiick Auslese of the Bavarian Palatinate. 



The Proscribed Fluids 

Compare, too, for the sake of further illustrating 
the difference among red wines, Ch?. u Lamarque 
of 1884, with its bouquet and flavour somewhat 
identical with that of black currant jelly, and 
Cta? du Cartillon of 1888, of the same commune, 
with its entirely different, more delicate flavour 
resembling that of the raspberry. 

It will thus be manifest at a glance how diver- 
gent are different growths of a given class of 
wines, as well as these same growths of different 
years; how varied their ethers, the amount of 
alcohol, acids, salts, tannin, and other ingredients 
they contain; how some may act as powerful 
stimulants, others as diuretics, and still others as 
soothing corroborants. Some are dry, others 
slightly sweet, or extremely saccharine ; some are 
sprightly, acting favourably upon the digestion ; 
some are soft, rich, and marrowy ; while all vary 
to a greater or lesser degree in their special bou- 
quets and flavours. Young wines, in addition, 
always differ from old wines in that many of 
their constituent properties are not yet precipi- 
tated, but still retained in the fluid ; and often the 
151 



Meditations on Gout 

former, from their greater briskness, agree bet- 
ter with some than the older, softer kinds. This 
applies only to the more ordinary varieties ; the 
finer sorts should either be left alone or only 
drunk at maturity. "The thinnest, whitest, 
smallest Wine is best, not thick nor strong ; and 
so of Beer the middling is the fittest," quoth Mas- 
ter Robert Burton, in his cure for melancholy. 

Little, if any, attention has been given by med- 
ical writers to the effects of white Burgundies; 
the term " Burgundy " usually being understood 
to mean a red wine of marked alcoholic potency, 
highly charged with uric toxine, and a near rela- 
tive of Port. It is questionable, however, whether 
some of the white growths of the Cote d'Or are 
not fully as admissible as those of the Rheingau 
— due regard being paid to the individual with 
whom white wines may or may not agree. Not 
a few of the white growths of Burgundy are less 
acid than those of the Rhine district, and often 
possess more unctuousness, without being sweet, 
and with no more or little more alcoholic force. 
There are very heady white Burgundies, as there 
152 



The Proscribed Fluids 

are very fiery Rhine wines ; and among the white 
growths of the Cote d'Or there exist a great 
variety — from the variable ordinaire, and dry 
and potent Pouilly, with its flinty taste, or the 
well-known Chablis, to the suave, nutty Meur- 
sault and priceless Montrachet. It remains for 
the analyst and physiologist to say whether the 
elements the Chaudenay grape has extracted 
from the soil are more or less salutary than those 
of its rival, the Riessling. 

As between white wines and red wines, the 
patient himself will be able to decide to the best 
advantage; the former acting adversely with 
some upon the nervous system, as well as pro- 
voking acidity ; the latter proving astringent, 
heating, or binding, to others. White wines are 
usually most stimulating and most rapidly ab- 
sorbed ; red wines most nutritive and blood -pro- 
ducing. The matter of "nerves" would not 
appear to enter into the case in Germany, where 
the principal wines drunk are the products of the 
Rhine, and where nervousness is almost an un- 
known quantity ; whereas with the more impres- 
153 



Meditations on Gout 

sionable French, Bordeaux or some species of red 
wine is the form most generally consumed. 

The consideration, however, of the hygienic 
qualities of red versus white wines for certain 
conditions or temperaments is a very old one. 
Leaving the ancients out of the question, as long 
ago as the middle of the sixteenth century, when 
Sack, Canary, Malmsey, Muscadel, Rhenish, Ro- 
chelle (or the wines of the provinces of Poitou 
and Saintonge), Guienne, and Gascony were drunk 
in Great Britain, — Dean William Turner called 
attention to the dissimilar effects of white and 
red species, with reference, if not to Gout, at least 
to a somewhat kindred kidney disorder, gravel. 
" Both French, Clared, and Gascony wines are 
not thin and subtle," he declares, "but strong, 
thick, and hot." His comments on " claret," by 
which presumably he implies a red wine from 
Guienne no less than Gascony, would indicate, as 
is familiar to many, that the red wines of the 
Bordelais at that period were of an entirely dif- 
ferent quality and made from different grapes 
than they are now. It is known that the growths 
i54 



The Proscribed Fluids 

of the Dordogne, adjoining that of the Gironde, 
both of which provinces are in the department of 
Guienne, together with the products of Tarn, 
and also those of Macau, Margaux, Blaye, Bourg, 
and other communes of the Medoc proper, were 
largely consumed in England in olden days, when 
the demand was for robust, " strong, sharp, and 
full-flavoured " wines. So that the strictures of 
the author relative to " claret " become perfectly 
intelligible, and apply with equal force at present 
to many kinds of wine, though not to the Medoc 
growths. " Both French, Clared, and Gascony 
Clared wines," he continues, " are of grosser and 
thicker substance, and hotter of complexion than 
white Rhenish wine and white French wines be 
of: therefore they breed the stone more than 
white Rhenish and white French wines do." 1 

All the white wines of the Bordelais and also 
of the Rhine, whatever the varieties of grapes of 
which they were formerly composed, we know 
were pressed from a single gathering, and not 

1 Notes on Wines in England ; A New Book on the 
Nature and Properties of Wines, etc. (1568). 

155 



Meditations on Gout 

from different gatherings or grain by grain, as is 
now the case in the Sauternes district and as also 
prevails extensively in the finer growths of the 
Rheingau and Rhenish Bavaria. 

From what has been observed respecting dif- 
ferent kinds of wine, it may readily be conceived 
that a mistake in the choice of growths may be 
the means of involving a whole train of arthritic 
disasters. For while water has been pronounced 
dangerous, wine is still less to be trifled with. 
Remarque^ qu'une seule erreur seme de la graine 
d'erreur, says Chevreul, — a precept that applies 
with striking relevancy to Gout. If a single bot- 
tle of wine may sometimes summon the enemy, 
how much more may a binful of a certain cru, 
where it disagrees with a particular subject, invite 
a chronic dyscrasia that may lead to chalkstones, 
or end in smiting the heart with fatal results ! 

How all-important, then, that one should only 
drink such species and varieties as are best suited 
to his peculiar constitution, condition, and tem- 
perament ; or drink a white or a red wine accord- 
ing as it assimilates best with the kinds of food 
156 



The Proscribed Fluids 

to be partaken of ! Fancy a person who is re- 
stricted by his physician to " claret," washing 
down his Blue- Points with a sour St. Julien to 
set up an acetous fermentation ; or another, who 
is confined to sherry, deluging a capon with 
Amontillado ! " Idiosyncrasy is as apt to be as 
marked in respect to wine as in respect to articles 
of diet, and should be taken into account," ob- 
serves Ewart. " The qualities we should look 
for in a wine for habitual use," he adds, " are a 
moderate percentage of alcohol and of ethers; 
the least possible degree of acidity ; freedom 
from unfermented sugar as far as this is consist- 
ent with a natural unadulterated condition ; free- 
dom from tannin ; genuineness as to vintage, or 
at least, as to derivation, mixed wines being most 
likely to do harm ; and, lastly, mature age. 
The difficulty in securing these essentials is per- 
haps greater now than at any previous period, 
and adds to the strength of the general objection 
to wines in Gout." x 

1 Dr. William Ewart, Gout and Goutiness and their 
Treatment. 

157 



Meditations on Gout 

While Champagne is invariably invested with 
a red flag of danger, as Port is always labelled, 
" Look out for the cars ! " — it may well be 
questioned if the charge against it be not much 
too sweeping, and whether, if moderately par- 
taken of in a rather dry form and of irreproach- 
able quality, it does not act as a tonic and 
digester. Still, like many other things, this will 
depend upon the individual, — human digestion 
being as varied in its complexion as the human 
physiognomy. Among medical authorities who 
have written upon the subject at length, Gran- 
ville is virtually the only exception in recom- 
mending the use of Champagne in Gout. 1 This 
wine was also favoured in the past century by 
Sir Edward Barry, Fellow of the Royal College 
of Physicians. 2 

As bad cookery is responsible for much indi- 
gestion, and as wine varies so greatly in its com- 
ponent parts and the effects of its varieties upon 

1 Dr. J. Mortimer Granville, Notes and Conjectures on 
Gout. 
2 Observations on the Wines of the Ancients. 
153 



The Proscribed Fluids 

various persons, may not the obstinacy of the 
malady be largely dependent, accordingly, upon 
the excellence or the demerits of the cuisine and 
the wine-cellar ? Again, as diversity in foods is 
a most important dietetic consideration, does it 
not follow, pari passu, that a diversity of wines 
is of equal consequence? Instead of being 
hedged in with one kind, therefore, which soon 
palls upon the taste, may not an ampler vinous 
pasturage be chosen, and a variety, within certain 
bounds, be vastly more desirable ? 

It has already been observed that certain fruits 
disagree with certain individuals. The delicious 
strawberry, in particular, is a violent poison to 
many, having frequently proved an excitant in 
developing an attack of Gout; and despite Dr. 
Boteler's eulogy, it is known to be prolific of 
violent gastralgia, painful urticaria, and intense 
stomatitis. Others experience disastrous effects 
from eating raspberries, red and black currants, 
apples, quinces, oranges, bananas, grape-fruit, and 
various other fruits, both native and tropical. 

How, then, can a physician prescribe wine in- 
i59 



Meditations on Gout 

telligently, which invariably resembles or sug- 
gests some kind of fruit, without being not only 
familiar with the constitution of his patient, 
and his physical likes and dislikes, but also with- 
out being a wine-drinker himself, and intimately 
acquainted with the varieties of wines? No 
doubt, also, many of those who are subject to 
Gout are equally ignorant in this respect; and 
some particular growth or growths, or some 
particular species that they are in the habit of 
drinking, counts for an important cause of their 
stomachic derangement so far as wines are con- 
cerned. 

For why should not the elemental parts con- 
tained in wine be as important a factor as those 
contained in mineral waters and natural springs, 
which differ so greatly in their effects ? But with 
the doctors, as in As You Like It, wine invaria- 
bly "comes out of a narrow-mouthed bottle; 
either too much at once, or none at all." Clearly, 
the doctors are at fault ; and wine may after all 
be a good familiar creature, and the sun's best 
use be "to warm the grape." As in angling, 
1 60 



The Proscribed Fluids 

"all winds are hurtful if too hard they blow," 
and the worst of winds is an east wind ; so with 
wine, all kinds may be harmful if partaken of 
too generously, and of these Port and Burgundy 
are the most detrimental. 

As wine, with its engaging perfume and ex- 
hilarating flavour, is so efficacious in many forms 
of sickness; as it proves so cheering to the 
senses and provocative of good-fellowship when 
partaken of in moderation ; as, moreover, the 
vine grows, and thrives, and ripens its ruby, 
roseate, and golden fruit on arid soils where no 
other useful plants could find a sustenance, — 
would it not seem a natural consequent that its 
expressed juices were pre-eminently designed by 
Nature for the health and solace of mankind? 
And differing so widely as constitutions do, may 
not a potent cause of the disease under considera- 
tion be the use of certain forms that are inimi- 
cal to the individual, rather than to the mere use 
of wine per se ? 

A person who is subject to Gout, therefore, 
should exercise the greatest care in the choice of 
ii 161 



Meditations on Gout 

such wines as meet his particular requirements ; 
and having once found such growths, he should 
religiously abstain from the ordinary wines of 
commerce, however alluring the labels and golden 
the capsules. A conscientious wine-merchant, ac- 
cordingly, who has the reputation of vineyards of 
his own at stake, a merchant who is thoroughly 
familiar with the wines of his district, and who 
may be absolutely relied upon to send samples not 
only true to name, but of a mise irreprochable 
so far as their bottling is concerned, becomes the 
greatest essentiality in a cure of Gout by the 
means of wine. His price is above rubies, and 
his remedy needs no bush. To the majority of 
wine-drinkers, however, this great desideratum 
exists solely as an unknown quantity. And 
when one further considers the marvellous versa- 
tility of the French barrique, under the necro- 
mancy of numerous middlemen, to discharge " St. 
Julien," " Pontet-Canet," and " Ch^ Larose " by 
a mere turn of the spigot, the difficulty of pro- 
curing a pure wine, true to name, becomes 
the more readily apparent. It may be asserted 
162 



The Proscribed Fluids 

within bounds that the average annual produc- 
tion of the Pauillac vineyard of Pontet-Canet, 
amounting- to one hundred and eighty tuns, 
would not suffice for a tenth part of the wine 
which is consumed under that name alone. 

With relation to the cure of Gout through the 
use of wine, the following dialogue which took 
place in the writer's presence, is presented ver- 
batim for the benefit of the afflicted. A short 
time since two distinguished prelates, who are 
fond of the pleasures of the table and who are 
both occasionally troubled with arthritic com- 
plaints, met on the street after a somewhat ex- 
tended absence. 

" Ah I bon jour, Monsignor," observed the 
one ; " I am delighted above measure. Have you 
been abroad again and just returned ? " 

"Mais non, mon cher Reverend" was the 
reply; "it has been too hot this summer for 
travelling, and now it is too damp in Europe. 
You know we must be careful and nurse our 
rheumatism." 

" Surely ! and in order the better to correct it, 
163 



Meditations on Gout 

we cannot be too guarded in drinking any but 
the very best wine." 

"Mais ouif" replied Monsignor, with em- 
phasis; " et jamais laisser une goutte dans son 
verre." 

The mot of the eminent prelate and the advice 
of his right-reverend confrere are certainly worthy 
of embalming ; the antidote and prescription be- 
ing much more agreeable than colchicum ; though 
good wine — " I'bonnete verre oU rit un peu 
d'oubli divin " — is far less readily procured. 
Let it not be understood, however, that this eccle- 
siastical counsel was intended to apply to wine in 
general. For while both of the distinguished 
divines attribute their usual well-being to its 
moderate employment, their vinous indulgence 
consists principally in the delicate juices of the 
Cabernet, Merlot, and Malbec of the Medoc, of 
well-succeeded years, to the almost entire exclu- 
sion of the fierier growths of the Cote d'Or and 
the South, — a case of Timothy's "a little wine 
for thy stomach's sake," rather than Rabelais's 
"fontaine caballine." 

164 



The Proscribed Fluids 

In a similar vein of advice to the ecclesiastical 
counsel recorded, are the lines of Maistre Jean 
Le Houx : — 

" La goutte ung drolls vHaff route, 
Qui boit sans songier au compte : 
Auares en sont saints, 
Qui ont les escus moi^is." 

Gout attacks not merry sot 
Cost of drink who counteth not ; 
Misers are of gout diseased, 
Who have crowns by mildew seized. 

One will also recall the dialogue between the 
Old Man and the Physician, in the inimitable 
Chansons du Vaux de Fire, where good wine is 
likewise prescribed as a cure : — 

LE VIEILLARD. 

La goutte aux joinctures des os 
Me tient alors que le temps change, 
Si bien que fen pets le repo^. 

LE MEDECIN. 

De decoction de vendange 
Recipe, trois voltes & plus : 
Ne songe tant en tes escus. 

*6 5 



Meditations on Gout 

LE VIEILLARD. 

Tous vos receptes sont de vin, 
Le vin, est ce cho^e si bonne ? 
Sans lui ne serie^ medecin ! 

LE MEDECIN. 
A tous ceulx-la le vin fordonne, 
Qui en humeur me sont e'gaulx, 
Car le vin garit tous mes maulx. 

OLD MAN. 

In change of weather gout doth keep 
The joints of all my bones in pain, 
So that at night I cannot sleep. 

PHYSICIAN. 

Recipe: — Three times o'er again, 
And more, decoction of the vine ; 
Don't heed so much those crowns of thine. 

OLD MAN. 

Your Recipes are always wine. 

Is wine so very good a thing? 
Without it, fails your medecine I 

PHYSICIAN. 

I'm always safe in ordering 
Those of my humour such a dose ; 
For wine alone cures all my woes. 
166 



The Proscribed Fluids 

Indeed, floating with the jolly Norman bard 
upon the roseate tide of the Vaux de Vire, it is 
difficult not to believe that alone by the generous 
use of wine may one expect to avoid Gout, but 
equally the countless petty miseries of life which 
charge upon one on every side, — that for all 
mundane ailments and vexations, the fermented 
juice of the grape is the sole and supreme ne- 
penthe. Like the olden handwriting upon the 
wall, his morale ever stands out in bold italic 
type: — 

Auec repos, auec contentement 

Vsons des liens que le del nous enuoye ; 
II ne f ant pas, f aide d'vnpeu de ioye, 

Le bee en Veau, nos jours precipiter. 

In rest and sweet contentment let us take 
The blessings Heav'n deigns lovingly to send ; 
And not for lack of what some joy can lend, 

By water-drinking, death anticipate. 1 

1 James Patrick Muirhead's translation. 



167 



THE QUANDARY 



THE QUANDARY 




The grief thereof him wondrous sore diseas'd, 

Ne might his rankling pain with patience be appeas'd. 

Spenser. 

T will be seen that no thera- 
peutist as yet, in this great 
age of progress, has thrown 
an X-ray on the prevention 
and cure of the malady. Ac- 
cording" to general medical 
consension, it is as impossible to eradicate it, as 
it is to cultivate the Edelweiss or the Maenner- 
treu. It virtually remains where it was in 
Sydenham's day, with colchicum and abstinence 
as its chief specifics, which are within the means 
of every one to prescribe. 

It is obdurate and implacable. Once the 

precedent formed by the stomach of allowing 

alcoholic fluids and gravies to rush into the 

feet ; once the enemy having been permitted to 

171 



Meditations on Gout 

obtain a foothold — it is next to impossible to 
rout him effectually, whatever the means of 
defence adopted. He may be starved out possi- 
bly, at the expense of the general health; but 
all the halberds, hauberks, and arblasts of the 
physicians are powerless to banish him perma- 
nently. And as the dinner is the true promoter, 
abettor, and accomplice of the malady, it would 
seem that it is only by cutting off this meal 
entirely that one may hope to overcome the foe. 

A weathercock as well as a wolf, the disease is 
not only extremely protean throughout its mani- 
fold forms, but in its erratic moods of a single 
form. The slightest pretext may sometimes 
induce its recurrence ; as, on the contrary, more 
particularly in the acute form, one may escape an 
attack for a long period, though the enemy be 
unduly and even persistently provoked. 

"There is no disease," observes John Mason 
Good, who was a sufferer himself, " to which the 
human frame is subject, that has led to such a 
variety of opinions, many of them directly con- 
tradictory to each other ; and, I may add, there 
172 



The Quandary 

is no disease concerning the nature and treatment 
of which physicians are so little agreed ; so that 
to this moment it constitutes perhaps the widest 
field for empiricism, and the hottest for warfare 
of any that lie within the domain of medical 
science," 1 — an echo of Cullen's phrase: " The 
gout, not only as it occurs in different persons, 
but even as it occurs in the same person at differ- 
ent times, is a disease of such various appearance 
that it is difficult to render the history of it 
complete and exact, or to give a character of it 
that will universally apply." 2 " We feel con- 
vinced," remarks Trousseau, " notwithstanding 
the pretensions of modern medicine, that we have 
made no advance since the time of Sydenham in 
our knowledge in the treatment, phenomena, and 
special nature of gout." 3 

In view of these declarations by the Magi 
themselves, how may the patient be guided ? To 
abide by the counsels of numerous advisers is a 

1 The Study of Medicine. 

2 First Lines of the Practice of Physic. 

3 Lectures on Clinical Medicine. 

i73 



Meditations on Gout 

physical impossibility. To carry out that of any 
given one may even be attended with fatal 
results, as Trousseau himself has recounted in 
the case of a patient whom he had in charge 
during his early practice. 

At the best, the victim will experience a sorry 
time. No longer may his waistcoat wear the 
enseigne of Rabelais, Fay ce que voudras, but 
rather bear the burden of Lucretius, Surgit amari 
aliquid, as he dons the sackcloth of vegetarian- 
ism or submits to the martyrdom of hydropathy. 
Good-cheer may no longer be his; each dish 
must forever be weighed in the balance. There 
may be no more sauce Tartare, no vol au vents, 
no lobster a la Newburgh, no ceufs Commadore — 
no Volnay, no Bass, no Munchner ! He must 
perforce be metred, and at the table have water 
flow as freely as Champagne. For the mantling 
beads of the Marne, he must be content with the 
riotous gurgle of Apollinaris, or drown his sor- 
rows in a geyser. Arise he must betimes, and 
seek communion with the dawn. In place of 
courting the whims of his palate, he must cater to 
174 



The Quandary 

the vagaries of his stomach. He must eschew 
society, and make friends with his porridge. 
Hear the dismal chorus of his monitors ! 

Gouty patients should be absolutely forbidden 
to go to dinners even if they promise to be very 
moderate (Niemeyer) ; salmon, pork, veal, and 
salads are to be avoided (Aitken) ; it is essential 
to be very sober, and not to eat food difficult of 
digestion (Trousseau) ; his beverage should be 
cool and unstimulant (Good) ; acid articles should 
be forbidden (Strumpell) ; to prevent overloading 
the stomach, the number of meals should be 
limited (Senator) ; beer and ale in any form are 
to be avoided (Mendelson) ; we must strictly 
regulate the hours of his meals (Sydenham) ; 
pastry of all kinds should be interdicted (Rob- 
erts) ; asparagus is to be avoided or used with 
great moderation ; tomatoes, rhubarb, and sorrel 
are exceedingly acid, and usually disagree (Ewart). 

Nor is this sufficient ; all looks yellow to their 
jaundic'd eye. 

A captain's biscuit or two, thoroughly soaked 
in milk and water, is the best bread food (Cham- 
*75 



Meditations on Gout 

bers) ; Champagne, sherries, Burgundy, Madeira, 
the different Rhine and Mosel wines should be 
carefully avoided (Hare) ; those wines which are 
most acceptable are good clarets, hock, Mosel, 
Chablis, and Sauterne (Roberts); extreme mod- 
eration should be observed when saccharine fruits 
are eaten (Garrod); spirits have a tendency to 
cause both fatty and fibrous degeneration, while a 
single glass of port wine will often produce pain- 
ful twinges, and a similar effect is not infrequently 
noticed from hock, Champagne also often exciting 
an attack in gouty persons (Morris) ; all culinary 
delicacies should be absolutely forbidden (Senator). 

Still the chorus continues — unyieldingly, de- 
terminedly, prohibitively, contradictorily : 

A casual glass or two of Champagne may suf- 
fice to bring the enemy suddenly upon one 
(Watson) ; some are inclined to look upon the 
albuminoids as most injurious, while others con- 
sider the carbo-hydrates equally as bad (Hare) ; 
dry sherry and the light wines, as claret, Bur- 
gundy, hock, Champagne, etc., may be drunk, 
certainly in moderation, although any kind of 
176 



The Quandary 

wine appears capable of sometimes acting as the 
exciting cause of a paroxysm (Pavy) ; spirits and 
the drier wines are the best suited to gouty per- 
sons, wines having much less tendency than spirits 
to damage the liver, and much less tendency than 
malt-liquors to bring on gout (Budd) ; gin is to 
be preferred from its diuretic tendency (Flint) ; 
there is no such thing as a temperate use of 
spirits (Alden); dried apples, pears, and prunes 
form a pleasant desert for the gouty (Mendelson) ; 
this disease seldom attacks eunuchs (Cullen). 

Avoid foods that please and drink drinks that 
displease ! they cry in concert, if not in unison, — 
and the scourge of Gout will wield a softer thong ; 
by thus abstaining you may not hope to avert 
the lash, it is true, but the number of the strokes 
may be lessened. It is but the oft repeated cry, 
most tersely expressed by Jacques Tahureau in 
his poem, De La Vanit'e des Hommes : 

"Tout ce que l'homme fait, tout ce que l'homme pense 

En ce bas monde ici, 
N'est rien qu'un vent legier, qu'une vaine esperance 

Plaine d'un vain souci. 

12 I?7 



Meditations on Gout 

" L'homme mortel n'est rien qu'une simple fumee 

Qui passe tout soudain ; 
Ce n'est rien qu'une poudre a tous vens promenee 

Que de ce cors humain." 

[All that man does, all that man thinks 

In this world here below, 
Is but the breath of a breeze, a hope unattain'd, 

Full of care and of woe. 

For man is scarce more than a shifting shade, 

To come and to pass ; 
And nought but a powder and toy of the wind, 

Is his body, alas !] 

Verily, in so much wisdom there is much grief ; 
and manifestly he who would increase his knowl- 
edge but increaseth his sorrow. In the name of 
the lovely goddess Hygeia, and in the face of 
so many prescriptions and proscriptions, what is 
the poor sufferer to do to avoid not only 
acute Gout, but suppressed, cerebral, asthenic, 
anomalous, gastro-enteric, cardiac, diaphrag- 
matic, visceral, chalky, metastatic, extra-articular, 
and the " flying " form — except to flee from the 
Gradgrinds and resign himself to his fate ? 

The great desideratum — a sure alterative, cor- 
178 



The Quandary 

rective, or an astomotic that will anticipate and 
foil the foe — remains hopelessly undiscovered. 
Where the vaunted pharmacopoeia of the 
menders of disease — the countless herbs, barks, 
and products of the vegetable and mineral king- 
doms that exist for the healing of the nations ? 
And while doctors continue to disagree, who shall 
decide ? 

It has been shown that besides many other 
organs, the spleen is possibly connected in some 
occult way with the diathesis of the disorder, and 
has its part to play in the dyscrasia. Yet how 
often do we hear of a physician alluding to this 
mysterious functionary ; or, in the case of Gout, 
attempting to force it to maintain the peace of 
the internal household ? To all but Professor 
Senator its exact role would appear to be utterly 
unknown. How many of the moderns are even 
aware that they possess a spleen ? The ancients 
were wiser, and rightly held it to be the seat of 
melancholy and anger. What doctor withal has 
devoted so much as an instant's thought to the 
comforts that might be afforded by so simple a 
179 



Meditations on Gout 

support and means of defence as an Alpenstock 
within constant reach of the patient ? 1 And who 
beyond Fothergill has ever noted that the east 
wind finds out the liver, albeit it lies intrenched 
beneath the diaphragm and is carefully guarded 
by the abdominal walls ? 2 " The east wind comes 
with sickness on its wings," saith the author of A 
Club of One, " and rejoiceth only the doctor and 
the sexton." Mist and fog that shroud the land- 
scape, yet bring near-by objects into more than 
usual relief, are likewise known to accentuate 
disturbances of the system. The weather, there- 
fore, may be responsible for much more in the 
aetiology of disease than it has been credited with 
by medical writers who have attempted to inter- 
pret the phenomena of disease. And of all the 
phases and mutations of the weather-vane, the 
east wind is most irritating to arthritic affections ; 
and, accordingly, may be a potent though as yet 
unacknowledged cause of Gout. 

1 Gouty patients generally acquire a morose, suscepti- 
ble, and irascible temper, formerly foreign to them. — 
Trousseau. 

2 Dr. J. Milner Fothergill, Indigestion and Biliousness. 

1 80 



The Quandary 

Neither, to speak in all seriousness, have medi- 
cal advisers, with scarcely an exception, in their 
treatment of the subject, referred to one of the 
great promoters of the malady, inasmuch as it 
constitutes one of the most frequent sources of 
indigestion, — rapid eating, and eating between 
meals, or drinking alcoholic beverages between 
meals. Writers are equally silent regarding the 
use of tobacco. Whether this may prove an 
excitant in a reflex way to those predisposed, 
through its effects upon the nervous system, as 
well as upon the gastric functions, is a question 
worthy of consideration, the more so as a smoker 
invariably smokes to his full capacity. The same 
may be said respecting some other features of 
dietetics, notably the failure of physicians to in- 
sist upon their patients who may be addicted to 
the use of stimulants, to make a point of always 
drinking an equal quantity of water at their 
meals. 

Sydenham and Cullen are almost alone in 
emphasising constipation as, if not a direct, at any 
rate an indirect cause of Gout in numerous in- 



Meditations on Gout 

stances. Insufficient stress, likewise, is laid upon 
change of air and scene, which means equally a 
change of diet, for those who may be predis- 
posed or who have acquired the malady. Un- 
doubtedly the advantages of periodical abstention 
and dieting, constitute one of the best prophy- 
lactics. Moreover, to thoroughly enjoy a thing, 
one needs to experience occasional denial. Few 
are aware of the voluptuousness of asceticism 
practised at intervals, in the renewed zest it gives 
to the palate, and the rest it imparts to a jaded 
digestion. Thus the Lenten abnegation enjoined 
by the Catholic religions, in place of a penance 
becomes a stomachic ; and the Friday fast of the 
Roman Catholic church a most excellent sanitary 
measure. 

Why attempt to pamper to appetite until appe- 
tite rebels, or try to combat the stomach when 
the stomach cries for rest? There invariably 
comes a time when we all must say, Bonjour 
lunettes ! adieu fillettes ! What signifies a sa- 
voury entree or an hour of gustatory delight, com- 
pared with the penalties they exact ? And, after 



The Quandary 

all, is it not mainly the first step in renunciation 
which costs ? " Begin a reformation, and custom 
will make it easy," saith Elia. And quoth wise 
Montaigne, " All meanes that may bring us unto 
health cannot be esteemed of men either sharpe 
or deare." Once the patient has practised ab- 
stemiousness for a short period, he will find his 
path a flowery one, freed to a large extent from 
the tares of indigestion. The over-taxed stomach 
will regain its tone, the liver its sprightliness. 
Plethora will gradually diminish, the senses be- 
come sharpened, and a state of well-being ensue 
that will doubly recompense him for his forbear- 
ance, and place him in position to enjoy the din- 
ners that the future holds in store. " All is habit, 
even virtue itself," Metastasio has declared ; and 
appetite and habit notoriously grow upon that by 
which they are nourished. Again, it would be 
well for all to ponder a wise sentence of Temple's : 
"It is certain that pleasures depend upon the 
temper of the body ; and that to enjoy them a 
man must be well himself, as the vessel must be 
sound to have your wine sweet. Whoever will 
183 



Meditations on Gout 

eat well must have a stomach ; who will relish 
the pleasure of drinks must have his mouth in 
taste ; who will enjoy a beautiful woman must be 
in vigour himself." x 

These reflections necessarily lead to the consid- 
eration of a matter of still greater moment — the 
neglect in the schools and colleges and seats of 
learning of sufficiently recognising and inculcat- 
ing hygiene, through lack of which one does not 
learn until too late the penalties attached to the 
violation of its statutes or the consequences en- 
tailed by an insufficient knowledge of the laws of 
health. Then, when disease attacks and ills 
assail, one realises how easy the preventive would 
have been if applied in time. 

While it will be sufficiently apparent from the 
foregoing remarks, which refer to the treatment 
of the malady, that no detailed formula can be 
laid down to cover each separate instance, but 
that each in a certain measure calls for a different 
mode of procedure, still, the following observa- 
tions will be applicable to the majority of cases : — 
1 On Health and Long Life. 
184 



The Quandary 

First of all, anything that tends to promote 
general health will prove of immediate benefit, — 
such as regular hours; moderation in drinking; 
plain though nourishing food ; the avoidance of 
rich, sweet, and heavy wines, and where wine is 
drunk the use for the most part of a sound Bor- 
deaux, a light white Graves or Entre Deux Mers, 
or a Tiscbwein of the Rheingau or Mosel ; the 
abstention from malt liquors, notably Porter 
and heavy ales ; the abstemious use of sweets and 
acids ; abundance of open air and exercise ; and 
sufficient change of air and scene. To these may 
be added the use of lithia or potash, and mild 
laxatives if required, or such tonics, aperients, 
or diuretics as one's medical adviser may pre- 
scribe; the avoidance of rapid eating, worry, 
and undue excitement; the employment of cool 
baths or the Turkish bath ; and a thorough use 
of the flesh-brush or crash-towel twice a day. 

Or, to place the matter in another form — 

where one has been accustomed to a full and 

liberal dietary, it should be reduced; where it 

has been illiberal, it should be enriched. In the 

185 



Meditations on Gout 

one case the steam must be shut off ; in the other, 
turned on. In any event, it is unadvisable to 
starve or to feast. Where mind or body has 
been overtaxed, it should be soothed; where 
sedentary habits have prevailed, regular exercise 
must ever be brought to bear, whilst one's motto 
must be elimination, elimination, elimination! 
through the kidneys, through the bowels, through 
the skin. If the kidneys are blocked, or the 
bowels sluggish, the remaining emunctory is the 
skin ; and this has its influence, and should be 
rigorously spurred into action. 

It may be said that wine in Gout is one of 
those things it is hard to get along with, and hard 
to get along without. To proscribe it, to a per- 
son who has long been accustomed to it, is to 
tamper with his digestion and general health ; to 
prescribe it as a tonic or digestive, as vaguely 
prescribed by the doctors, is to present a vulner- 
able point to the enemy. The patient who is 
naturally subject to the malady, thus stands be- 
tween two fires — the torch of dyspepsia and the 
touchwood of arthriticism, with little hope of 
186 



The Quandary 

escaping the flames in either case. But with 
reference to wine, it may be observed that there 
are wines and wine; and he who turns these 
pages must be artless indeed who cannot read 
sufficiently between the lines to choose a sort that 
will aid him in his cure, and bear out the exegesis 
of the persuasive Advocate of Vire : — 

Se treuuent trois lettres en Vin, 
Qui font Vigueur, Ioie, Nourriture, 
Et dhiotent bien sa nature, 

Comme diet fort bien mon voisin. 

Three letters which in VIN are found 
Mean Vigour, Joy, and Nutriment : 
My neighbour well says, thus are meant 

Three gifts that in good wine abound. 

It is from good wine alone, of course, that any 
alleviation may be expected. Wine in itself is a 
dangerous expedient ; and it cannot be reiterated 
too often that it is only by employing the exact 
kind, best suited to the requirements of the par- 
ticular individual and stage of the malady, that 
one may hope to outflank and elude the foe. 



187 



THE INDUCTION 



THE INDUCTION 

Cogimur a snetis animum suspender e rebus : 

Atque ut vivamus, vivere desinimus. 

Pseudo-Gallus. 
From things erst us'd we must suspend our minde, 
We leave to live that we may live by kinde. 

IT may finally be observed 
[that Gout is but a compara- 
tively minor infliction among 
the countless physical ailments 
| which in various guises assail 
the human race, — that the 
man or woman who is permanently exempt from 
any constitutional disorder, be it inherited or ac- 
quired, is a far greater anomaly than exists in any 
disease itself. Eucrasy, or absolute soundness of 
health in the human species, is as rare as the uni- 
corn in the animal kingdom : for if man, as he 
rounds out his half century of the brief span al- 
lotted him, be besieged by no organic evils, it is 
191 




Meditations on Gout 

a thousand to one that he is harrowed by some 
infirmity of the mind or senses. For hath it not 
been decreed that every man shall bear his own 
burden, and he that is born of a woman is of few 
days and full of trouble ? Even the chronic 
sufferer, if he be afflicted by no other malady and 
hampered by no impairment of the sensory func- 
tions, has much to be thankful for. If he be 
deprived of the pleasures of the table to a great 
degree, he may yet contemplate a monk of 
Tambourini holding up his glass of wine upon 
the canvas, or peruse the Almamcb des Gour- 
mands and The Physiology of Taste, with no 
dread of arthritic pains to follow. With smiling 
landscapes upon his walls and Oriental rugs upon 
his floors, he may still revel in colours as rich as 
those the vat reveals ; and in the flowers of his 
garden find bouquets to rival those of the best 
succeeded Haut-Brion and Montrachet. His 
cigar and his brier will have lost none of their 
fragrance and consolation, while possibly even in 
water he will be enabled to discover virtues not 
dreamed of in his erstwhile philosophy. From 
192 



The Induction 

the table, he can turn with renewed appreciation 
to the tomes of the moralists, and find an added 
charm in the musings of Pascal and Montaigne. 
Delights innumerable may still be his — the 
world has not grown old : — 

" The boon thou hast not had, 
'T is a slight, trivial thing to make thee sad, 
When with the sunshine and the storm God's glorious 
world is glad. 

" The word is not yet said 
Of ultimate ending, we are quick, not dead, 
Though the dim years withhold from us one frail joy 
coveted. 

" Our life is all too brief, 
The world too wide, too wonderful for grief, 
Too crowded with the loveliness of bird and bud and leaf. 

" So though we said good-bye 
With bitter futile tears, my dream and I — 
Each slender blade of wayside grass is clothed with 
majesty." 1 

Perchance the most philosophical way for the 
sufferer is to take up a treatise of medicine, and 

1 A Morning Walk, Cornhill Magazine. 
*3 193 



Meditations on Gout 

perusing it attentively, note the innumerable ills 
that flesh is heir to which are infinitely worse 
than his own. And while he ponders over life's 
uncertainties and recognises that mankind was 
created to suffer and endure, as well as to rejoice 
and enjoy, if he be a minute philosopher he 
may conclude his reflections with this corollary, 
as, were he not afflicted with Gout, he might 
top off his dinner with a glass of Port, — in one 
form or another, sooner or later, one must pay 
the penalty of living ; and what can a man live 
long enough to know except that he is born to 
die? 



194 



INDEX 



INDEX 

AbERNETHY, Sir John, quoted 89 

Acidity, in fruits 101, 103-108 

" in wine 121, 152 

" vagaries of 102 

Acids and acidity 20,40,91,100,185 

Acids, lactic 39, 41 

" uric 17,31,37,39,95,117 

" uric acid diathesis 44, 53 

" volatile fatty 39 

A Club of One, quoted 89,180 

Aitken, Dr., quoted 175 

Alcohol, digestion of, in combination with foods 50, 125 
Alcoholic beverages .... 19, 20, 94, 98, 117 et seq. 

Alden, Dr., quoted 177 

Ale 45, 126, 140, 185 

(See also Beer and Malt Liquors.) 

Alkalies as alteratives 72 

America, growing prevalence of Gout in 52 

Arsenic as an alterative 71 

Asceticism, voluptuousness of 182 

BARRY, Sir Edward, quoted 136,158 

Bathing 84, 185 

Baths, thermal 83-85 

Bechamel, Count, anecdote of ill 



Index 

Beer, enormous amount consumed in Germany . 45, 119 

" excellence of German 45, 126 

" in Gout 101, 130 

" of Great Britain 45, 126 

" of the United States 45, 52 

(See also Malt Liquors.) 

Bencke, Dr., referred to 102 

Biliousness 30 

Blood, alkalinity of . . . 40, 43, 72, 86, 101-105, 106 

" oxygenation of 55 

Boteler, Dr., referred to 159 

Brandy 120, 125, 144 

Budd, Dr., quoted 177 

Burton, Robert, quoted 58,91,152 

CANDIES, adulteration of 21 

Carles, Dr. P., quoted 48 

Carlyle, quoted 56 

Carman, Bliss, quoted 28, 33 

Celery 92 

Chalkstones 29, 59, 156 

Chambers, Dr. Thomas K., quoted 18,175 

Change of air and scene 182, 185 

Charcot, Dr., referred to 42 

Chevreul, quoted 156 

Cheyne, Dr., anecdote of ill 

Cider 118 

Cinchona as an alterative 71 

Climate as a promoter 44 

Clymer, Dr. Meredith, quoted 17 

Colchicum 7,69,171 

Complexions, lovely, in lame girls 28 

Constipation 57, 181 

108 



Index 

Cookery 12,51,96,158 

Cowper, quoted 5 

Cullen, Dr., quoted 19,80,93,173,177 

" re f errec i to 60, 77, 78, 181 

Culpepper, quoted 75 

Cure of Gout through the use of wine. See Gout. 

Diabetes no, us 

" in wine countries 47 

Dickens, quoted 14 

Diet, best form of in Gout 96 

Digestion, different forms of 91 

" disturbances of 17, 39, 92, 101 

" joys of a good 57, 96 

" price of a good 98 

Dinner (the) the great promoter 172 

Distilled spirits vs. wine 89, 119, 120 

Doctors, references to. See Physicians. 

Drinking between meals 144, 181 

Dyspepsia 1,2,20,30,41,56,94,121,186 

EARLY rising as a prophylactic 81,174 

East wind, the 180 

Ecclesiasticus, quoted 114 

Elderberries, in Port 137 

Emerson, quoted ill 

Eucrasy 191 

Eunuchs, advantages of 177 

Ewart, Dr., quoted .... 13,22,101,102,157,175 

Ewing, Dr., quoted 61 

" " referred to 104 

Exercise in connection with Gout 52-54, 56, 81, 84, 129, 

185, 186 
199 



Index 
Flatulency 30,57 

Flint, Dr. Austin, quoted 42 

" quoted 177 

Foods, acid-provoking 101 

" as responsible as alcoholic fluids 50 

" noxious and innocuous 92, 95 

" vs. alcohol 50, 120 

Forbes, Dr. Murray, referred to 37 

Fothergill, Dr., referred to 180 

Fourcroy, Dr., referred to 37 

French, alimentation of the 51 

Fruits, appointed time to use 108 

" as promoters 101, 103-108, 159 

GAIRDNER, Dr., quoted 27 

Galen, referred to 8, 118 

Garrod, Dr., referred to . . 38, 50, 60, 72, 73, 84, 85, 103 

" quoted 14,83,120,121,176 

Gastralgia, its cure by wine 148 

Gastric disorders 30 

" fermentation. . . . 57,90,105,107,157,159 

Gastronomy vs. Gout 10, 23, 48 

Gerarde, quoted 70, 75 

Gelatine 92 

Germans, alimentation of 46 

" Gout among the 45 

Goer is, Dr., statement regarding wine 129 

Good, John Mason, quoted 17,172,175 

Gout, abstinence as a preventive 61 

" acidity the prominent causative factor . . . 101 

" alkalinity of the blood in 40, 43, 100 

" allied to rheumatism 31, 41-43 

" an abnormal disease 24 

200 






Index 



Gout, an individual disease 103 

an old master's cure through the use of wine ill 

a plebeian disease 8, 18 

asceticism vs. moderation in 94 

a strange feature of the malady 65 

a sure cure for 89 

champagne and madeira beneficial for . . 131, 158 

chosen times of visitation 27, 32 

considered a goddess by the ancients .... 6 
contradictory chorus of physicians . . 175-178 
cravings of the palate sometimes wise to heed 109 

fruits as promoters 101, 103-108 

general causes of 16, 17, 19, 43 

good Bordeaux wine not a cause of ... 130 

indices of an attack. 64 

its advances subtle and insidious .... 63 
its cure through the use of wine 112, 131, 162, 163, 

164, 165, 187 

lead poisoning in 15 

madeira bad for 132 

means of prevention 61 

of what is its nature ? 3 

opposing theories of the disease 95 

prevalence of in different countries .... 44 

in England 9, 11-14, 135 

" in olden times 5 

Professor Senator on diet 97 

prognosis of 2, 59 

strawberries and fruits as promoters ... 159 

the black-list of wine 118 

the disease defined 23 

the milk diet in . . 95 

various forms of 27,59,103,178 

water alone a dangerous beverage .... 122 
201 



Index 

Goutiness 12, 29-31, 102, 103 

" a normal condition of mankind .... 31 

Gout-weed 75 

Gouty tendency, man born with a 31 

Grammont, Count, referred to . 69 

Granville, Dr., referred to 158 

Grape-fruit as a promoter 90, 105, 159 

Gravel, in wine countries 47,155 

Graves, Dr., his remedy 78 

Guaiacum, as an alterative 73, 74 

HABIT, the thrall of 99,183 

Haig, Dr. Alex., quoted 95 

" « re f erre( j to 42 

Hare, Dr., quoted 176 

Hay, John, quoted 94 

Herb-Gerrard 75 

Hereditary predisposition 13-15 

Herrick, referred to 134 

Home, Rev. John, quoted 141 

Horace, quoted 6, 19 

Hoy, Dr. Albert Harris, quoted 41, 52, 104 

Huet, referred to 76 

Hume, David, anecdote of 141 

Hutchinson, Dr. J., quoted 42 

Hygiene, in the schools 184 

" its golden rules 114 

Indigestion . 1,17,20,30,56,64,81,108,130,131,158 

Iodine, as a specific 71 

Iron " " 71 

JEROPIGA, its use in Port 137, 142 

202 



Index 

La FONTAINE, quoted 117 

Lamb, quoted 183 

Le Houx, Jean, quoted . 165, 187 

Lenten fast, advantages of the 182 

Levison, Dr. F., referred to 44 

Linnaeus, referred to 103 

Lithia as an-alterative 72, 73, 185 

Living, philosophy of 191-194 

Lowell, quoted 132 

Lucian, quoted 6 

Lucretius, quoted 174 

MAGNESIA as an alterative 72 

Mal-assimilation . . 5, 18, 20, 30, 32, 43, 50, 57, 96, 133 
Mal-elimination .... 5, 18, 30, 38, 40, 41, 43, 186 
Malt-liquors . . . 16,44,45,89,118,125,126,144 

" vs. wine 49 

(See also Beer and Ale, 185.) 

Mankind, born to suffer 192, 194 

Markham, Gervaise, quoted 76 

Mendelson, Dr., quoted 175,177 

Mercury as an alterative 71 

Metastasio, quoted 183 

Methuen Treaty, The 135 

Miller, Hugh, referred to 54 

Milton, a victim 142 

Mineral springs 82 

" waters, use of in Gout 72, 98 

Montaigne, quoted 3,58,117,183 

Morris, Dr., quoted 176 

Mortality, periods of, in disease 60 

Mot, a famous clerical 164 

203 



Index 

NATURE, attractions of 54 

Nervousness, in Gout 22, 64, 153 

Neuralgia 41 

Niemeyer, Dr. Felix von, quoted . . . . 40,82,89,175 

" " referred to 85 

Nux vomica as an alterative 71 

Oat-meal 31,92 

Omar, quoted 62 

Oranges, as promoters 90,159 

PALATE, the, its longings sometimes wise to heed . 109 

Parsees of India great meat eaters 47 

Pavy, Dr. F. W., quoted 89, 118, 177 

Peckey, John, quoted 76 

Petrarch, referred to 134 

Physicians among the chosen victims ... 6, 23, 25, 172 

contradictory chorus of 175-177 

discrimination in the choice of ... . 31 
indirectly responsible for Gout .... 10 
Jean Le Houx as a wise physician ... 165 

killing their patients 1 74 

many opposing theories of 95 

misleading as prescribers of wine 145, 157, 160 

noted divines as 163 

one of the olden school 112 

powerless to exorcise the malady . . 6, 24, 69 
171, 172, 179 

should study their patients 100 

the spleen unknown to all but Professor 

Senator 179 

their duty to mankind 62, 63 

their impossibility to regulate the stomach 92 
204 



Index 

Physicians vs. pantologists 50 

Plethora 19, 183 

Pliny, quoted 145 

Port. See Wines. 

Porter, English 126, 140, 185 

Portland powder, its ingredients 77 

Potash as an alterative 72, 185 

Predisposition 15, 53, 93 

Preventive, difficult in all cases 11 

Pseudo-Gallus, quoted 191 

RABELAIS, referred to 76 

quoted 100,164,174 

Rapid eating, a cause of Gout .... 20, 43, 181, 185 

Rendu, Dr., quoted 22, 42 

Respiration, its function 55 

Rheumatic gout 25, 26, 42 

Rheumatism 7, 30, 31, 86, 94 

" resemblance to Gout 41 

Rice, in alcoholic fluids 126 

Richardson, Dr. Benjamin W., quoted 40 

Riches, ills of 58 

Roberts, Dr. F. T., quoted .... 40, 60, 144, 175, 176 

Salads 101, in 

Sarkosin, as an alterative 73 

Schultzen, Professor, referred to 73 

Scudamore, Sir Charles, quoted 13 

Senator, Professor, quoted . . 4, 40, 59, 72, 97, 175, 176 

" " referred to 100,179 

Serpentary, as an alterative 74 

Shakespeare, quoted 134, 160 

Shattuck, Dr. Frederick C, quoted 18 

205 



Index 

Shaw, Thomas George, quoted 132 

Soda as an alterative . 72 

" urate of 41 

Spenser, quoted 81, 171 

Spleen, the 39,179 

Stomach, impossible to stroke it the right way . 90, 92 

the 56,64,90,92,98,110,171 

Stomatitis 159 

Strawberries as promoters . 31, 90, 103, 105, 107, 125, 159 

Striimpell, Dr., quoted 4,175 

Strychnine as an alterative 71 

Sweets as promoters 21,91,107,121,185 

Sydenham, Dr., quoted . . . . 25,34,56,60,122,175 
" referred to . . . 50, 63, 171, 173, 181 

TAHUREAU, Jacques, quoted 177 

Teetotaler, joys of the 99 

Temple, Sir William, quoted 138, 183 

" " " referred to 79 

Tennant, Dr., referred to 37 

Tennyson (a victim), quoted 142 

Thomson, quoted 12 

Tobacco 181 

Trousseau, Dr., quoted . . 28, 41, 71, 122, 173, 175, 180 

" " referred to 85 

Turner, Dean William, quoted 154 

URIC acid. See Acids. 

Urticaria 22,159 

Vegetarianism 96,99,111 

Venery, a cause 20 

Vices, joys of the 99 

Voltaire, quoted 37 

206 



Index 

WaDE, Sir Willoughby, quoted 22 

Walton, referred to 53 

Water, dangers of the use of 122, 167 

" drinking at meals 181 

" virtues of 192 

Watson, Dr., quoted 176 

Watts, quoted 57 

Weather, the, as a promoter 180 

White, Gilbert, referred to 53 

Wine, best forms of 98 

" Chablis 124,144,153 

" Chaud'Yquem 146,147 

" Haut Brion 150, 192 

" " Lafaurie 147 

" countries comparatively free from Gout . . 47 
" cure of Gout through the use of . .112, 131, 163, 

165, 187 

" its baneful principle 106, 120, 124, 125 

" merchant, a conscientious ....... 162 

" of Entre Deux Mers 145, 148, 185 

" " St. Emilion 149 

" " the Graves 145, 148, 149, 185 

" Pontet Canet, marvellous capacity of that 

vineyard 162 

" Port, its baneful properties and history . 134-141 

" red to. white 154,156 

" Sack, Canary, and Palm 112, 154 

" Sauterne 118, 123, 144, 145-148 

" Sherry 118, 122, 157 

" should be " a mistress rather than a wife" . 140 

" use of in France 51, 119, 124 

" " " " Germany 119, 124 

" to. distilled spirits 89, 119, 120 

207 



Index 

Wine vs. malt liquors 49 

" what are its components ? 127 

Wines, account of ancient , 137,154 

" Bordeaux not a cause of Gout 130 

" Burgundy, adulterations of 134 

" Champagne 118, 131, 132, 158 

" " adulteration of 132 

" distinguishing characteristics of 128, 145, 151, 153 

" favorable to health 124 

c « in Gout 91 

" Madeira 118, 123, 131, 132 

" Mosel 129, 144, 150, 185 

" of Bordeaux . . 65, 121, 124, 130, 144, 149, 164 
" " the Bavarian Palatinate . . . 123, 150, 156 
" Port . 12, 118, 123, 130, 134 et seq., 158, 161, 194 

" red Burgundy 118, 130, 134, 161 

" Rhine 123, 129, 144, 150, 152, 185 

" saccharine, injurious effects of . 21, 118, 123, 146 

" Spanish 122, 136 

« the black-list of 118 

" various effects on various persons . . . 91,158 

" white Burgundy 124, 152 

Wollaston, Dr., referred to 37, 38 

Woman, as a factor in Gout 49, 50 

Women, as subjects 21 

Wordsworth, quoted 54 



208 



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